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"plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1000126", "drug_name": "1 ML medroxyprogesterone acetate 150 MG/ML Injection", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1000135", "drug_name": "medroxyprogesterone acetate 2.5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1000141", "drug_name": "medroxyprogesterone acetate 5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1000153", "drug_name": "1 ML medroxyprogesterone acetate 150 MG/ML Prefilled Syringe", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1000158", "drug_name": "0.65 ML medroxyprogesterone acetate 160 MG/ML Prefilled Syringe [depo-subQ provera]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1000405", "drug_name": "norethindrone acetate 5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1000913", "drug_name": "pilocarpine hydrochloride 5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1001004", "drug_name": "pilocarpine hydrochloride 7.5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1001409", "drug_name": "calcium carbonate 625 MG / ergocalciferol 125 UNT Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1005928", "drug_name": "ulipristal acetate 30 MG Oral Tablet [Ella]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1006065", "drug_name": "{21 (ethinyl estradiol 0.03 MG / levonorgestrel 0.15 MG Oral Tablet) / 7 (inert ingredients 1 MG Oral Tablet) } Pack [Altavera 28 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1006120", "drug_name": "sulfacetamide sodium 100 MG/ML Ophthalmic Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1006688", "drug_name": "sulfacetamide sodium 100 MG/ML Topical Lotion", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1006801", "drug_name": "clozapine 150 MG Disintegrating Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1009145", "drug_name": "amphetamine aspartate 1.875 MG / amphetamine sulfate 1.875 MG / dextroamphetamine saccharate 1.875 MG / dextroamphetamine sulfate 1.875 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1010600", "drug_name": "buprenorphine 2 MG / naloxone 0.5 MG Sublingual Film", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1010604", "drug_name": "buprenorphine 8 MG / naloxone 2 MG Sublingual Film", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1010732", "drug_name": "polyethylene glycol 3350 17000 MG Powder for Oral Solution [PureLax]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1010739", "drug_name": "lidocaine hydrochloride 20 MG/ML Mucous Membrane Topical Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1010878", "drug_name": "lidocaine hydrochloride 40 MG/ML Mucous Membrane Topical Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1011482", "drug_name": "cetirizine hydrochloride 10 MG Disintegrating Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1011870", "drug_name": "nicotine 2 MG Chewing Gum [Thrive]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1012021", "drug_name": "prednisolone sodium phosphate 2.5 MG/ML / sulfacetamide sodium 100 MG/ML Ophthalmic Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1012895", "drug_name": "fingolimod 0.5 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1013629", "drug_name": "{24 (drospirenone 3 MG / ethinyl estradiol 0.02 MG / levomefolate calcium 0.451 MG Oral Tablet) / 4 (levomefolate calcium 0.451 MG Oral Tablet) } Pack", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1013636", "drug_name": "calcipotriene 0.00005 MG/MG Topical Ointment [Calcitrene]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": true, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1014314", "drug_name": "triamcinolone acetonide 1 MG/ML Topical Cream", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1014571", "drug_name": "12 HR cetirizine hydrochloride 5 MG / pseudoephedrine hydrochloride 120 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1014573", "drug_name": "12 HR cetirizine hydrochloride 5 MG / pseudoephedrine hydrochloride 120 MG 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"drug_name": "cetirizine hydrochloride 1 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1014674", "drug_name": "cetirizine hydrochloride 10 MG Chewable Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1014675", "drug_name": "cetirizine hydrochloride 10 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1014676", "drug_name": "cetirizine hydrochloride 5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1014678", "drug_name": "cetirizine hydrochloride 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1020017", "drug_name": "cetirizine hydrochloride 1 MG/ML Oral Solution [Aller-Tec]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1020026", "drug_name": "cetirizine hydrochloride 10 MG Oral Tablet [Zyrtec]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1020126", "drug_name": "loratadine 10 MG Oral Tablet [Loradamed]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1020138", "drug_name": "dextromethorphan hydrobromide 1 MG/ML / guaifenesin 20 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1020155", "drug_name": "{84 (ethinyl estradiol 0.03 MG / levonorgestrel 0.15 MG Oral Tablet) / 7 (inert ingredients 1 MG Oral Tablet) } Pack [Introvale 91 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1020477", "drug_name": "diphenhydramine hydrochloride 50 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "103401", "drug_name": "hydrocortisone 0.025 MG/MG Topical Ointment", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "103403", "drug_name": "hydrocortisone 10 MG/ML Topical Lotion", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "103456", "drug_name": "fluocinonide 0.5 MG/ML Topical Cream", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "103457", "drug_name": "fluocinonide 0.0005 MG/MG Topical Ointment", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1037045", "drug_name": "dabigatran etexilate 150 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1037179", "drug_name": "dabigatran etexilate 75 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1037185", "drug_name": "{24 (ethinyl estradiol 0.01 MG / norethindrone acetate 1 MG Oral Tablet) / 2 (ethinyl estradiol 0.01 MG Oral Tablet) / 2 (ferrous fumarate 75 MG Oral Tablet) } Pack [Lo Loestrin Fe 28 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1038810", "drug_name": "polysaccharide iron complex 326.1 MG Oral Capsule [Iferex]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1039279", "drug_name": "hydrocortisone 10 MG/ML Topical Lotion [Cortizone]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "103951", "drug_name": "tolnaftate 10 MG/ML Topical Cream", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "103968", "drug_name": "lamotrigine 100 MG Disintegrating Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1039965", "drug_name": "sennosides, USP 17.2 MG Oral Tablet [Senokot]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1040031", "drug_name": "lurasidone hydrochloride 40 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1040041", "drug_name": "lurasidone hydrochloride 80 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1040054", "drug_name": "dextromethorphan hydrobromide 20 MG / quinidine sulfate 10 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "104062", "drug_name": "cimetidine 200 MG Oral Tablet [Tagamet]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "104094", "drug_name": "famotidine 20 MG Oral Tablet [Pepcid]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1041798", "drug_name": "propylene glycol 6 MG/ML Ophthalmic Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1043048", "drug_name": "bismuth subsalicylate 35 MG/ML Oral Suspension [Kaopectate Reformulated Aug 2006]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1043063", "drug_name": "hydrocortisone 10 MG/ML Topical Lotion [Aquanil HC]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1043074", "drug_name": "hydrocortisone 10 MG/ML Topical Lotion [Beta-HC]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1044524", "drug_name": "calcium carbonate 1000 MG Chewable Tablet [Tums]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1044532", "drug_name": "calcium carbonate 750 MG Chewable Tablet [Tums]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1045402", "drug_name": "dasatinib 140 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1045406", "drug_name": "dasatinib 80 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1046631", "drug_name": "dextromethorphan hydrobromide 2 MG/ML / guaifenesin 40 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1048445", "drug_name": "colestipol hydrochloride 1000 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1048450", "drug_name": "colestipol hydrochloride 5000 MG Granules for Oral Suspension", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "104884", "drug_name": "metoclopramide 1 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "104894", "drug_name": "ondansetron 4 MG Disintegrating Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1049154", "drug_name": "12 HR pseudoephedrine hydrochloride 120 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1049156", "drug_name": "12 HR pseudoephedrine hydrochloride 120 MG Extended Release Oral Tablet [Sudogest]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1049160", "drug_name": "pseudoephedrine hydrochloride 30 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1049162", "drug_name": "pseudoephedrine hydrochloride 30 MG Oral Tablet [Sudogest]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1049167", "drug_name": "pseudoephedrine hydrochloride 60 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1049169", "drug_name": "pseudoephedrine hydrochloride 60 MG Oral Tablet [Sudogest]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1049214", "drug_name": "acetaminophen 325 MG / oxycodone hydrochloride 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1049216", "drug_name": "acetaminophen 325 MG / oxycodone hydrochloride 10 MG Oral Tablet [Endocet]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1049221", "drug_name": "acetaminophen 325 MG / oxycodone hydrochloride 5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1049223", "drug_name": "acetaminophen 325 MG / oxycodone hydrochloride 5 MG Oral Tablet [Endocet]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1049225", "drug_name": "acetaminophen 325 MG / oxycodone hydrochloride 7.5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1049227", "drug_name": "acetaminophen 325 MG / oxycodone hydrochloride 7.5 MG Oral Tablet [Endocet]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1049529", "drug_name": "pseudoephedrine hydrochloride 30 MG Oral Tablet [Sudafed]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1049604", "drug_name": "oxycodone hydrochloride 1 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1049611", "drug_name": "oxycodone hydrochloride 15 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1049615", "drug_name": "oxycodone hydrochloride 20 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1049618", "drug_name": "oxycodone hydrochloride 30 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1049621", "drug_name": "oxycodone hydrochloride 5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1049630", "drug_name": "diphenhydramine hydrochloride 25 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1049632", "drug_name": "diphenhydramine hydrochloride 25 MG Oral Tablet [Benadryl]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1049635", "drug_name": "acetaminophen 325 MG / oxycodone hydrochloride 2.5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1049672", "drug_name": "24 HR pseudoephedrine hydrochloride 240 MG Extended Release Oral Tablet [Sudafed]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1049683", "drug_name": "oxycodone hydrochloride 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1049686", "drug_name": "oxycodone hydrochloride 20 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1049696", "drug_name": "oxycodone hydrochloride 5 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1049900", "drug_name": "diphenhydramine hydrochloride 12.5 MG Chewable Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1049906", "drug_name": "diphenhydramine hydrochloride 2.5 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1049909", "drug_name": "diphenhydramine hydrochloride 25 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1049910", "drug_name": "diphenhydramine hydrochloride 25 MG Oral Capsule [Benadryl]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1050493", "drug_name": "{21 (drospirenone 3 MG / ethinyl estradiol 0.03 MG / levomefolate calcium 0.451 MG Oral 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"plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1052658", "drug_name": "etravirine 200 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "105292", "drug_name": "isoniazid 10 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1053146", "drug_name": "mineral oil 0.319 MG/MG / petrolatum 0.577 MG/MG Ophthalmic Ointment [Stye]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "105551", "drug_name": "busulfan 2 MG Oral Tablet [Myleran]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "105553", "drug_name": "chlorambucil 2 MG Oral Tablet [Leukeran]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "105583", "drug_name": "fluorouracil 50 MG/ML Topical Cream", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "105585", "drug_name": "methotrexate 2.5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "106258", "drug_name": "hydrocortisone 10 MG/ML Topical Cream", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "106302", "drug_name": "tretinoin 0.25 MG/ML Topical Cream", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "106303", "drug_name": "tretinoin 0.5 MG/ML Topical Cream", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "106336", "drug_name": "ketoconazole 20 MG/ML Medicated Shampoo", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "106346", "drug_name": "mupirocin 0.02 MG/MG Topical Ointment", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "106351", "drug_name": "silver sulfadiazine 10 MG/ML Topical Cream", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "106387", "drug_name": "permethrin 50 MG/ML Topical Cream", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "106892", "drug_name": "insulin isophane, human 70 UNT/ML / insulin, regular, human 30 UNT/ML Injectable Suspension [Humulin]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "108396", "drug_name": "20 ML zidovudine 10 MG/ML Injection [Retrovir]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1085633", "drug_name": "triamcinolone acetonide 0.00025 MG/MG Topical Ointment", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1085636", "drug_name": "triamcinolone acetonide 0.001 MG/MG Topical Ointment", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1085640", "drug_name": "triamcinolone acetonide 0.005 MG/MG Topical Ointment", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1085644", "drug_name": "triamcinolone acetonide 0.25 MG/ML Topical Cream", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1085686", "drug_name": "triamcinolone acetonide 5 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"prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1085767", "drug_name": "triamcinolone acetonide 0.001 MG/MG Oral Paste [Oralone]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1085816", "drug_name": "spinosad 9 MG/ML Medicated Shampoo", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1086613", "drug_name": "mineral oil 0.15 MG/MG / petrolatum 0.83 MG/MG Ophthalmic Ointment [Lubrifresh P.M.]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1086767", "drug_name": "diphenhydramine hydrochloride 2.5 MG/ML Oral Solution [Wal-Dryl Childrens]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1086772", "drug_name": "vilazodone hydrochloride 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1086778", "drug_name": "vilazodone hydrochloride 20 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1086784", "drug_name": "vilazodone hydrochloride 40 MG Oral Tablet", "plans": [ { 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false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1087051", "drug_name": "loratadine 10 MG Oral Tablet [Wal-itin]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1087169", "drug_name": "cetirizine hydrochloride 10 MG Oral Tablet [Wal-Zyr]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1087410", "drug_name": "24 HR ascorbic acid 500 MG / biotin 0.15 MG / copper sulfate 3 MG / dl-alpha tocopheryl acetate 30 UNT / docusate sodium 50 MG / folic acid 1 MG / iron carbonyl 150 MG / vitamin B12 0.06 MG Extended Release Oral Tablet [Hemax]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1087414", "drug_name": "ascorbic acid 250 MG / folic acid 1 MG / iron carbonyl 100 MG / vitamin B12 0.025 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1088146", "drug_name": "mineral oil 0.15 MG/MG / petrolatum 0.85 MG/MG Ophthalmic Ointment [Altalube]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1088217", "drug_name": "dextran 70 1 MG/ML / hypromellose 3 MG/ML Ophthalmic Solution [Bion Tears]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1088531", "drug_name": "polyethylene glycol 3350 17000 MG Powder for Oral Solution [HealthyLax]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1088774", "drug_name": "potassium bicarbonate 25 MEQ Effervescent Oral Tablet [Effer-K]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1088779", "drug_name": "niacin 500 MG Extended Release Oral Tablet [Endur-Acin]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1088869", "drug_name": "ascorbic acid 250 MG / iron carbonyl 100 MG Oral Tablet [Icar C]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1090076", "drug_name": "diphenhydramine hydrochloride 25 MG Oral Capsule [Wal-Dryl Allergy]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1090078", "drug_name": "diphenhydramine hydrochloride 25 MG Oral Tablet [Wal-Dryl Allergy]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1090456", "drug_name": "diphenhydramine hydrochloride 50 MG Oral Capsule [Wal-Som Maximum Strength]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1090512", "drug_name": "loratadine 10 MG Disintegrating Oral Tablet [Wal-vert]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1090824", "drug_name": "ascorbic acid 60 MG / beta carotene 5000 UNT / copper sulfate 40 MG / dl-alpha tocopheryl acetate 30 UNT / sodium selenite 0.04 MG / zinc oxide 40 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1090992", "drug_name": "ethinyl estradiol 0.005 MG / norethindrone acetate 1 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1090996", "drug_name": "ethinyl estradiol 0.005 MG / norethindrone acetate 1 MG Oral Tablet [Jinteli]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1091133", "drug_name": "methylphenidate hydrochloride 2 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1091145", "drug_name": "8 HR methylphenidate 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"HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1091185", "drug_name": "24 HR methylphenidate hydrochloride 36 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1091210", "drug_name": "24 HR methylphenidate hydrochloride 54 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1091225", "drug_name": "8 HR methylphenidate hydrochloride 20 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": true, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1091341", "drug_name": "methylphenidate hydrochloride 1 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1091392", "drug_name": "methylphenidate hydrochloride 20 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1091497", "drug_name": "methylphenidate hydrochloride 5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1091623", "drug_name": "24 HR diltiazem hydrochloride 420 MG Extended Release Oral Tablet [Matzim]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1091629", "drug_name": "24 HR diltiazem hydrochloride 240 MG Extended Release Oral Tablet [Matzim]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1091632", "drug_name": "24 HR diltiazem hydrochloride 180 MG Extended Release Oral Tablet [Matzim]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1091635", "drug_name": "24 HR diltiazem hydrochloride 300 MG Extended Release Oral Tablet [Matzim]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1091638", "drug_name": "24 HR diltiazem hydrochloride 360 MG Extended Release Oral Tablet [Matzim]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1092357", "drug_name": "rufinamide 40 MG/ML Oral Suspension", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1092416", "drug_name": "diphenhydramine hydrochloride 25 MG Oral Tablet [Nytol]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1092421", "drug_name": "diphenhydramine hydrochloride 25 MG Oral Tablet [Banophen]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1092466", "drug_name": "diphenhydramine hydrochloride 25 MG Oral Tablet [Simply Sleep]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1094022", "drug_name": "calcium carbonate 1500 MG / cholecalciferol 500 UNT Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1094104", "drug_name": "phenazopyridine hydrochloride 200 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1094107", "drug_name": "phenazopyridine hydrochloride 100 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1094543", "drug_name": "{21 (ethinyl estradiol 0.035 MG / norethindrone 0.4 MG Oral Tablet) / 7 (inert ingredients 1 MG Oral Tablet) } Pack [Briellyn 28 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1095227", "drug_name": "{6 (ethinyl estradiol 0.03 MG / levonorgestrel 0.05 MG Oral Tablet) / 10 (ethinyl estradiol 0.03 MG / levonorgestrel 0.125 MG Oral Tablet) / 5 (ethinyl estradiol 0.04 MG / levonorgestrel 0.075 MG Oral Tablet) / 7 (inert ingredients 1 MG Oral Tablet) } Pack [Levonest 28 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1095362", "drug_name": "{21 (ethinyl estradiol 0.035 MG / norethindrone 0.4 MG Oral Tablet) / 7 (inert ingredients 1 MG Oral Tablet) } Pack [Balziva 28 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1095421", "drug_name": "ferrous sulfate 140 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1095712", "drug_name": "24 HR nevirapine 400 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1098134", "drug_name": "24 HR niacin 1000 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1098141", "drug_name": "24 HR niacin 500 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1098143", "drug_name": "24 HR niacin 750 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1098498", "drug_name": "brompheniramine maleate 0.2 MG/ML / pseudoephedrine hydrochloride 3 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1098608", "drug_name": "24 HR lamotrigine 300 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1098649", "drug_name": "nefazodone hydrochloride 100 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1098666", "drug_name": "nefazodone hydrochloride 150 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1098670", "drug_name": "nefazodone hydrochloride 200 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1098674", "drug_name": "nefazodone hydrochloride 250 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1098678", "drug_name": "nefazodone hydrochloride 50 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1099026", "drug_name": "{24 (drospirenone 3 MG / ethinyl estradiol 0.02 MG Oral Tablet) / 4 (inert ingredients 1 MG Oral Tablet) } Pack [Loryna 28 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1099074", "drug_name": "12 HR dextromethorphan hydrobromide 60 MG / guaifenesin 1200 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1099269", "drug_name": "{21 (drospirenone 3 MG / ethinyl estradiol 0.03 MG Oral Tablet) / 7 (inert ingredients 1 MG Oral Tablet) } Pack [Syeda 28 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1099279", "drug_name": "docusate sodium 100 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1099288", "drug_name": "desipramine hydrochloride 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1099292", "drug_name": "desipramine hydrochloride 100 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1099296", "drug_name": "desipramine hydrochloride 150 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1099300", "drug_name": "desipramine hydrochloride 25 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1099304", "drug_name": "desipramine hydrochloride 50 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1099316", "drug_name": "desipramine hydrochloride 75 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1099563", "drug_name": "24 HR divalproex sodium 250 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1099569", "drug_name": "24 HR divalproex sodium 500 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1099596", "drug_name": "divalproex sodium 125 MG Delayed Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1099625", "drug_name": "divalproex sodium 125 MG Delayed Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1099648", "drug_name": "5 ML valproic acid 100 MG/ML Injection", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1099678", "drug_name": "divalproex sodium 250 MG Delayed Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1099681", "drug_name": "valproic acid 250 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1099687", "drug_name": "valproic acid 50 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1099870", "drug_name": "divalproex sodium 500 MG Delayed Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1100075", "drug_name": "abiraterone acetate 250 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1100184", "drug_name": "donepezil hydrochloride 23 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1100457", "drug_name": "pyridoxine hydrochloride 25 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1100650", "drug_name": "carboxymethylcellulose sodium 5 MG/ML / glycerin 9 MG/ML Ophthalmic Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1101446", "drug_name": "doxylamine succinate 25 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1101938", "drug_name": "sodium fluoride 0.011 MG/MG Toothpaste [Dentagel]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1102273", "drug_name": "rilpivirine 25 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1111018", "drug_name": "sapropterin dihydrochloride 100 MG Powder for Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1111106", "drug_name": "fidaxomicin 200 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1111339", "drug_name": "olopatadine 1 MG/ML Ophthalmic Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1111343", "drug_name": "olopatadine 2 MG/ML Ophthalmic Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1111345", "drug_name": "olopatadine 2 MG/ML Ophthalmic Solution [Pataday]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1111641", "drug_name": "1 ML glatiramer acetate 20 MG/ML Prefilled Syringe", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1111752", "drug_name": "dexpanthenol 0.2 MG/ML / magnesium sulfate 0.0467 MG/ML / manganese sulfate 0.0467 MG/ML / niacinamide 0.467 MG/ML / pyridoxine 0.0467 MG/ML / riboflavin 0.04 MG/ML / thiamine 0.0333 MG/ML / vitamin B12 0.000133 MG/ML / zinc sulfate 0.333 MG/ML Oral Solution [Eldertonic]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1112231", "drug_name": "naproxen sodium 220 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1112233", "drug_name": "naproxen sodium 220 MG Oral Capsule [Aleve]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1112715", "drug_name": "{28 (ethinyl estradiol 0.02 MG / levonorgestrel 0.09 MG Oral Tablet) } Pack [Amethyst 28 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1114074", "drug_name": "vandetanib 100 MG Oral Tablet [Caprelsa]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1114096", "drug_name": "vandetanib 300 MG Oral Tablet [Caprelsa]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1114202", "drug_name": "rivaroxaban 10 MG Oral Tablet [Xarelto]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1115005", "drug_name": "docusate sodium 100 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1115698", "drug_name": "oseltamivir 6 MG/ML Oral Suspension", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1116150", "drug_name": "bacitracin zinc 0.4 UNT/MG / hydrocortisone acetate 0.01 MG/MG / neomycin sulfate 0.0035 MG/MG / polymyxin B sulfate 10 UNT/MG Ophthalmic Ointment", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1116511", "drug_name": "cholecalciferol 0.05 MG Oral Tablet [Thera-D]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1116528", "drug_name": "fexofenadine hydrochloride 180 MG Oral Tablet [Wal-Fex]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1116635", "drug_name": "ticagrelor 90 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1116758", "drug_name": "chloroquine phosphate 500 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1117531", "drug_name": "chloroquine phosphate 250 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1117562", "drug_name": "24 HR loratadine 10 MG / pseudoephedrine sulfate 240 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1119400", "drug_name": "everolimus 7.5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1119573", "drug_name": "ascorbic acid 30 MG / cholecalciferol 1000 UNT / cuprous oxide 2 MG / folic acid 1 MG / magnesium oxide 20 MG / niacin 15 MG / polysaccharide iron complex 29 MG / potassium iodide 0.15 MG / pyridoxine hydrochloride 2.5 MG / riboflavin 1.8 MG / thiamine mononitrate 1.6 MG / vitamin A 1100 UNT / vitamin B12 0.012 MG / vitamin E 20 UNT / zinc oxide 25 MG Oral Capsule [Vitafol-One]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1120068", "drug_name": "magnesium sulfate 0.0277 MEQ/ML / potassium sulfate 0.0374 MEQ/ML / sodium sulfate 0.257 MEQ/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1145114", "drug_name": "azelaic acid 5 MG / cupric oxide 1.5 MG / folic acid 0.5 MG / niacinamide 600 MG / pyridoxine 5 MG / zinc oxide 10 MG Oral Tablet [NicAzel]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1145991", "drug_name": "folic acid 2.5 MG / pyridoxine 25 MG / vitamin B12 1 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1146690", "drug_name": "24 HR lamotrigine 250 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1147334", "drug_name": "emtricitabine 200 MG / rilpivirine 25 MG / tenofovir disoproxil fumarate 300 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1147924", "drug_name": "dextromethorphan hydrobromide 6 MG/ML / guaifenesin 40 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1148399", "drug_name": "8 HR acetaminophen 650 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1149667", "drug_name": "{7 (ethinyl estradiol 0.01 MG Oral Tablet) / 84 (ethinyl estradiol 0.03 MG / levonorgestrel 0.15 MG Oral Tablet) } Pack [Camrese 91 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1150836", "drug_name": "levobunolol hydrochloride 5 MG/ML Ophthalmic Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1188426", "drug_name": "carboxymethylcellulose sodium 5 MG/ML Ophthalmic Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1189781", "drug_name": "aspirin 81 MG Delayed Release Oral Tablet [Ecotrin]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1190110", "drug_name": "fluoxetine 60 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1190334", "drug_name": "24 HR fexofenadine hydrochloride 180 MG / pseudoephedrine hydrochloride 240 MG Extended Release Oral Tablet [Wal-Fex D]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1190568", "drug_name": "atropine sulfate 0.005 MG/ML / diphenoxylate hydrochloride 0.5 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1190572", "drug_name": "atropine sulfate 0.025 MG / diphenoxylate hydrochloride 2.5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1190655", "drug_name": "atropine sulfate 10 MG/ML Ophthalmic Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, 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"1193337", "drug_name": "ruxolitinib 10 MG Oral Tablet [Jakafi]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1193341", "drug_name": "ruxolitinib 5 MG Oral Tablet [Jakafi]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1193345", "drug_name": "ruxolitinib 15 MG Oral Tablet [Jakafi]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1193349", "drug_name": "ruxolitinib 20 MG Oral Tablet [Jakafi]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1193353", "drug_name": "ruxolitinib 25 MG Oral Tablet [Jakafi]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1193358", "drug_name": "100 ML levetiracetam 10 MG/ML Injection", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1193360", "drug_name": "100 ML levetiracetam 15 MG/ML Injection", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1193362", "drug_name": "100 ML 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"GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1233031", "drug_name": "cholecalciferol 0.05 MG Chewable Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1233032", "drug_name": "cholecalciferol 0.125 MG Chewable Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1233850", "drug_name": "{24 (drospirenone 3 MG / ethinyl estradiol 0.02 MG Oral Tablet) / 4 (inert ingredients 1 MG Oral Tablet) } Pack [Vestura]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, 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"22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1235262", "drug_name": "mineral oil 0.2 MG/MG / petrolatum 0.8 MG/MG Ophthalmic Ointment [Soothe Night Time]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1235267", "drug_name": "{7 (ethinyl estradiol 0.01 MG Oral Tablet) / 84 (ethinyl estradiol 0.02 MG / levonorgestrel 0.1 MG Oral Tablet) } Pack [CamreseLo 91 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1235591", "drug_name": "raltegravir 100 MG Chewable Tablet [Isentress]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1235595", "drug_name": "raltegravir 25 MG Chewable Tablet [Isentress]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1235867", "drug_name": "{7 (ethinyl estradiol 0.035 MG / norethindrone 0.5 MG Oral Tablet) / 7 (ethinyl estradiol 0.035 MG / norethindrone 0.75 MG Oral Tablet) / 7 (ethinyl estradiol 0.035 MG / norethindrone 1 MG Oral Tablet) / 7 (inert ingredients 1 MG Oral Tablet) } Pack [Dasetta 7/7/7 28 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1235874", "drug_name": "{21 (ethinyl 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"lenalidomide 2.5 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1242391", "drug_name": "24 HR loratadine 10 MG / pseudoephedrine sulfate 240 MG Extended Release Oral Tablet [Claritin-D]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1242397", "drug_name": "24 HR loratadine 10 MG / pseudoephedrine sulfate 240 MG Extended Release Oral Tablet [Wal-itin D]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1242399", "drug_name": "12 HR loratadine 5 MG / pseudoephedrine 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"{7 (ethinyl estradiol 0.035 MG / norethindrone 0.5 MG Oral Tablet) / 7 (ethinyl estradiol 0.035 MG / norethindrone 0.75 MG Oral Tablet) / 7 (ethinyl estradiol 0.035 MG / norethindrone 1 MG Oral Tablet) / 7 (inert ingredients 1 MG Oral Tablet) } Pack [Alyacen 7/7/7]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1242998", "drug_name": "vismodegib 150 MG Oral Capsule [Erivedge]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1243010", "drug_name": "axitinib 1 MG Oral Tablet [Inlyta]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1243014", "drug_name": "axitinib 5 MG Oral Tablet [Inlyta]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1243052", "drug_name": "ivacaftor 150 MG Oral Tablet [Kalydeco]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1243229", "drug_name": "tenofovir disoproxil fumarate 250 MG Oral Tablet [Viread]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1243326", "drug_name": "tenofovir disoproxil fumarate 150 MG Oral Tablet [Viread]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1243330", "drug_name": "tenofovir disoproxil fumarate 200 MG Oral Tablet [Viread]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1243346", "drug_name": "tenofovir disoproxil fumarate 0.04 MG/MG Oral Powder [Viread]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1244214", "drug_name": "budesonide 3 MG Delayed Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1244675", "drug_name": "12 HR guaifenesin 1200 MG / pseudoephedrine hydrochloride 120 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1245376", "drug_name": "docusate calcium 240 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1245468", "drug_name": "docusate sodium 250 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1245686", "drug_name": "docusate sodium 10 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1245919", "drug_name": "{21 (ethinyl estradiol 0.03 MG / levonorgestrel 0.15 MG Oral Tablet) / 7 (inert ingredients 1 MG Oral Tablet) } Pack [Marlissa 28 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1246310", "drug_name": "120 ACTUAT formoterol fumarate 0.005 MG/ACTUAT / mometasone furoate 0.1 MG/ACTUAT Metered Dose Inhaler [Dulera]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { 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39150 UNT / lipase 10440 UNT / protease 39150 UNT Oral Tablet [Viokace]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1247756", "drug_name": "docusate sodium 100 MG Oral Capsule [Colace]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1247761", "drug_name": "docusate sodium 50 MG Oral Capsule [Colace]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1248013", "drug_name": "docusate sodium 50 MG / sennosides, USP 8.6 MG Oral Tablet [Senexon S]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1248015", "drug_name": "docusate sodium 50 MG / sennosides, USP 8.6 MG Oral Tablet [SENOKOT-S]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1248119", "drug_name": "docusate sodium 10 MG/ML Oral Suspension", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1250090", "drug_name": "nonoxynol-9 0.03 MG/MG Vaginal Gel [Gynol II]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1250282", "drug_name": "aluminum hydroxide 160 MG / magnesium carbonate 105 MG Chewable Tablet [Acid Gone]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1250723", "drug_name": "etravirine 25 MG Oral Tablet [Intelence]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1251334", "drug_name": "{28 (ethinyl estradiol 0.0025 MG / norethindrone acetate 0.5 MG Oral Tablet) } Pack", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1251336", "drug_name": "{28 (ethinyl estradiol 0.005 MG / norethindrone acetate 1 MG Oral Tablet) } Pack", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1251355", "drug_name": "aluminum hydroxide 6.33 MG/ML / magnesium carbonate 23.9 MG/ML Oral Suspension [Acid Gone]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1251398", "drug_name": "sodium chloride 6.5 MG/ML Nasal Spray [Ocean brand of sodium chloride]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1251495", "drug_name": "84 HR estradiol 0.00208 MG/HR / norethindrone acetate 0.00583 MG/HR Transdermal System [Combipatch]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1251501", "drug_name": "84 HR estradiol 0.00208 MG/HR / norethindrone acetate 0.0104 MG/HR Transdermal System [Combipatch]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1251903", "drug_name": "ethacrynic acid 25 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1252016", "drug_name": "{21 (desogestrel 0.15 MG / ethinyl estradiol 0.02 MG Oral Tablet) / 5 (ethinyl estradiol 0.01 MG Oral Tablet) / 2 (inert ingredients 1 MG Oral Tablet) } Pack [Viorele 28 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1291276", "drug_name": "cholecalciferol 1.25 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1292459", "drug_name": "0.5 ML varicella-zoster virus vaccine live (Oka-Merck) strain 2700 UNT/ML Injection [Varivax]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1293942", "drug_name": "acetaminophen 500 MG Oral Tablet [Pharbetol]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1297278", "drug_name": "lurasidone hydrochloride 120 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1297389", "drug_name": "calcium carbonate 1250 MG / cholecalciferol 200 UNT Oral Tablet [Oysco 500 with D]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1297658", "drug_name": "esomeprazole 2.5 MG Granules for Oral Suspension", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1297761", "drug_name": "esomeprazole 5 MG Granules for Oral Suspension", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1298066", "drug_name": "cyclopentolate hydrochloride 10 MG/ML Ophthalmic Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1298324", "drug_name": "12 HR dextromethorphan hydrobromide 30 MG / guaifenesin 600 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1298360", "drug_name": "cyclopentolate hydrochloride 2 MG/ML / phenylephrine hydrochloride 10 MG/ML Ophthalmic Solution [Cyclomydril]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1298427", "drug_name": "ivermectin 5 MG/ML Topical Lotion [Sklice]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1298816", "drug_name": "molindone hydrochloride 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1298830", "drug_name": "acetaminophen 325 MG Oral Tablet [Pharbetol]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1298906", "drug_name": "molindone hydrochloride 25 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1298910", "drug_name": "molindone hydrochloride 5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1299244", "drug_name": "12 HR loratadine 5 MG / pseudoephedrine sulfate 120 MG Extended Release Oral 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2026 ] } ] }, { "rxnorm_id": "1300206", "drug_name": "0.5 ML Bordetella pertussis filamentous hemagglutinin vaccine, inactivated 0.01 MG/ML / Bordetella pertussis fimbriae 2/3 vaccine, inactivated 0.01 MG/ML / Bordetella pertussis pertactin vaccine, inactivated 0.006 MG/ML / Bordetella pertussis toxoid vaccine, inactivated 0.005 MG/ML / diphtheria toxoid vaccine, inactivated 4 UNT/ML / tetanus toxoid vaccine, inactivated 10 UNT/ML Injection [Adacel]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1300310", "drug_name": "0.5 ML Bordetella pertussis filamentous hemagglutinin vaccine, inactivated 0.01 MG/ML / Bordetella pertussis fimbriae 2/3 vaccine, inactivated 0.01 MG/ML / Bordetella pertussis pertactin vaccine, inactivated 0.006 MG/ML / Bordetella pertussis toxoid vaccine, inactivated 0.02 MG/ML / diphtheria toxoid 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0.05 MG/ML / Bordetella pertussis pertactin vaccine, inactivated 0.016 MG/ML / Bordetella pertussis toxoid vaccine, inactivated 0.05 MG/ML / diphtheria toxoid vaccine, inactivated 50 UNT/ML / tetanus toxoid vaccine, inactivated 20 UNT/ML Prefilled Syringe [Infanrix]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1300538", "drug_name": "{21 (ethinyl estradiol 0.035 MG / norethindrone 1 MG Oral Tablet) / 7 (inert ingredients 1 MG Oral Tablet) } Pack [Dasetta 1/35 28 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1300791", "drug_name": "24 HR mirabegron 25 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1300801", "drug_name": "24 HR mirabegron 50 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1300911", "drug_name": "{21 (ethinyl estradiol 0.035 MG / norethindrone 0.5 MG Oral Tablet) / 7 (inert ingredients 1 MG Oral Tablet) } Pack [Wera 28 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1303916", "drug_name": "cholecalciferol 1.25 MG Oral Tablet [Dialyvite Vitamin D3 Max]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1304979", "drug_name": "icosapent ethyl 1000 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1304988", "drug_name": "{21 (ethinyl estradiol 0.02 MG / levonorgestrel 0.1 MG Oral Tablet) / 7 (inert ingredients 1 MG Oral Tablet) } Pack [Falmina 28 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1305089", "drug_name": "{21 (ethinyl estradiol 0.03 MG / norgestrel 0.3 MG Oral Tablet) / 7 (inert ingredients 1 MG Oral Tablet) } Pack [Elinest 28 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1305603", "drug_name": "12 HR guaifenesin 600 MG / pseudoephedrine hydrochloride 60 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1305757", "drug_name": "{7 (ethinyl estradiol 0.025 MG / norgestimate 0.18 MG Oral Tablet) / 7 (ethinyl estradiol 0.025 MG / norgestimate 0.215 MG Oral Tablet) / 7 (ethinyl estradiol 0.025 MG / norgestimate 0.25 MG Oral Tablet) / 7 (inert ingredients 1 MG Oral Tablet) } Pack [Tri-Lo-Marzia 28-Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1306298", "drug_name": "cobicistat 150 MG / elvitegravir 150 MG / emtricitabine 200 MG / tenofovir disoproxil fumarate 300 MG Oral Tablet [Stribild]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1307056", "drug_name": "buprenorphine 4 MG / naloxone 1 MG Sublingual Film", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1307061", "drug_name": "buprenorphine 12 MG / naloxone 3 MG Sublingual Film", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1307415", "drug_name": "linaclotide 0.145 MG Oral Capsule [Linzess]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1307421", "drug_name": "linaclotide 0.29 MG Oral Capsule [Linzess]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1307427", "drug_name": "sildenafil 10 MG/ML Oral Suspension", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1308569", "drug_name": "24 HR rivastigmine 0.554 MG/HR Transdermal System", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1310525", "drug_name": "teriflunomide 14 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1310533", "drug_name": "teriflunomide 7 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1311535", "drug_name": "{7 (ethinyl estradiol 0.035 MG / norgestimate 0.18 MG Oral Tablet) / 7 (ethinyl estradiol 0.035 MG / norgestimate 0.215 MG Oral Tablet) / 7 (ethinyl estradiol 0.035 MG / norgestimate 0.25 MG Oral Tablet) / 7 (inert ingredients 1 MG Oral Tablet) } Pack [TRI-LINYAH]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1312408", "drug_name": "regorafenib 40 MG Oral Tablet [Stivarga]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1312625", "drug_name": "loteprednol etabonate 0.005 MG/MG Ophthalmic Gel", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1313112", "drug_name": "phenytoin 25 MG/ML Oral Suspension", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1313885", "drug_name": "phenytoin 50 MG Chewable Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1314672", "drug_name": "ascorbic acid 210 MG / biotin 0.3 MG / calcium pantothenate 7 MG / copper sulfate 0.8 MG / ferrous fumarate 130 MG / folic acid 1 MG / magnesium sulfate 6.9 MG / manganese sulfate 1.3 MG / niacin 20 MG / polysaccharide iron complex 92.4 MG / pyridoxine hydrochloride 25 MG / riboflavin 5 MG / thiamine mononitrate 5 MG / vitamin B12 0.01 MG / zinc sulfate 18.2 MG Oral Capsule [Concept OB]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1314763", "drug_name": "tobramycin 75 MG/ML Inhalation Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1356074", "drug_name": "{21 (ethinyl estradiol 0.03 MG / levonorgestrel 0.15 MG Oral Tablet) / 7 (inert ingredients 1 MG Oral Tablet) } Pack [Kurvelo]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1356557", "drug_name": "perampanel 2 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1356570", "drug_name": "perampanel 4 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1356574", "drug_name": "perampanel 6 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1356578", "drug_name": "perampanel 8 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1356582", "drug_name": "perampanel 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1356586", "drug_name": "perampanel 12 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1357010", "drug_name": "brompheniramine maleate 0.4 MG/ML / dextromethorphan hydrobromide 2 MG/ML / pseudoephedrine hydrochloride 6 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1357541", "drug_name": "tofacitinib 5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1358471", "drug_name": "loratadine 10 MG Disintegrating Oral Tablet [Wal-itin]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1358765", "drug_name": "{21 (ethinyl estradiol 0.02 MG / norethindrone acetate 1 MG Oral Tablet) / 7 (ferrous fumarate 75 MG Oral Tablet) } Pack [Junel Fe 1/20 28 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1358770", "drug_name": "{21 (ethinyl estradiol 0.02 MG / norethindrone acetate 1 MG Oral Tablet) / 7 (ferrous fumarate 75 MG Oral Tablet) } Pack [Loestrin Fe 1/20 28 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1358775", "drug_name": "{21 (ethinyl estradiol 0.02 MG / norethindrone acetate 1 MG Oral Tablet) / 7 (ferrous fumarate 75 MG Oral Tablet) } Pack [Microgestin Fe 1/20 28 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1358776", "drug_name": "{21 (ethinyl estradiol 0.02 MG / norethindrone acetate 1 MG Oral Tablet) } Pack", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1358780", "drug_name": "{21 (ethinyl estradiol 0.02 MG / norethindrone acetate 1 MG Oral Tablet) } Pack [Junel 1/20 21 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1358781", "drug_name": "{21 (ethinyl estradiol 0.02 MG / norethindrone acetate 1 MG Oral Tablet) } Pack [Loestrin 1/20 21 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1359020", "drug_name": "{21 (ethinyl estradiol 0.02 MG / norethindrone acetate 1 MG Oral Tablet) } Pack [Microgestin 1/20 21 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1359025", "drug_name": "{21 (ethinyl estradiol 0.03 MG / norethindrone acetate 1.5 MG Oral Tablet) / 7 (ferrous fumarate 75 MG Oral Tablet) } Pack [Junel Fe 1.5/30 28 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1359026", "drug_name": "{21 (ethinyl estradiol 0.03 MG / norethindrone acetate 1.5 MG Oral Tablet) / 7 (ferrous fumarate 75 MG Oral Tablet) } Pack [Loestrin Fe 1.5/30 28 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1359027", "drug_name": "{21 (ethinyl estradiol 0.03 MG / norethindrone acetate 1.5 MG Oral Tablet) / 7 (ferrous fumarate 75 MG Oral Tablet) } Pack [Microgestin Fe 1.5/30 28 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1359030", "drug_name": "{21 (ethinyl estradiol 0.03 MG / norethindrone acetate 1.5 MG Oral Tablet) } Pack [Junel 1.5/30 21 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1359031", "drug_name": "{21 (ethinyl estradiol 0.03 MG / norethindrone acetate 1.5 MG Oral Tablet) } Pack [Loestrin 1.5/30 21 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1359032", "drug_name": "{21 (ethinyl estradiol 0.03 MG / norethindrone acetate 1.5 MG Oral Tablet) } Pack [Microgestin 1.5/30 21 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1359124", "drug_name": "{28 (estradiol 0.5 MG / norethindrone acetate 0.1 MG Oral Tablet) } Pack", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1359127", "drug_name": "{28 (estradiol 1 MG / norethindrone acetate 0.5 MG Oral Tablet) } Pack", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1359129", "drug_name": "{28 (estradiol 1 MG / norethindrone acetate 0.5 MG Oral Tablet) } Pack [Mimvey]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1359134", "drug_name": "{5 (ethinyl estradiol 0.02 MG / norethindrone acetate 1 MG Oral Tablet) / 7 (ethinyl estradiol 0.03 MG / norethindrone acetate 1 MG Oral Tablet) / 9 (ethinyl estradiol 0.035 MG / norethindrone acetate 1 MG Oral Tablet) / 7 (ferrous fumarate 75 MG Oral Tablet) } Pack [Tilia Fe]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1359135", "drug_name": "{5 (ethinyl estradiol 0.02 MG / norethindrone acetate 1 MG Oral Tablet) / 7 (ethinyl estradiol 0.03 MG / norethindrone acetate 1 MG Oral Tablet) / 9 (ethinyl estradiol 0.035 MG / norethindrone acetate 1 MG Oral Tablet) / 7 (ferrous fumarate 75 MG Oral Tablet) } Pack [Tri-Legest 28 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1359269", "drug_name": "darunavir 800 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1359345", "drug_name": "bacitracin 0.4 UNT/MG / neomycin 0.0035 MG/MG / polymyxin B 10 UNT/MG / pramoxine hydrochloride 0.01 MG/MG Topical Ointment [Lanabiotic]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1362706", "drug_name": "mexiletine hydrochloride 150 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1362712", "drug_name": "mexiletine hydrochloride 200 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1362720", "drug_name": "mexiletine hydrochloride 250 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1363288", "drug_name": "12 HR chlorpheniramine maleate 12 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1363306", "drug_name": "chlorpheniramine maleate 0.4 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1363309", "drug_name": "chlorpheniramine maleate 4 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1363315", "drug_name": "chlorpheniramine maleate 4 MG Oral Tablet [Aller-Chlor]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1363323", "drug_name": "chlorpheniramine maleate 4 MG Oral Tablet [Wal-finate]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1363408", "drug_name": "{84 (cabozantinib 20 MG Oral Capsule [Cometriq]) / 28 (cabozantinib 80 MG Oral Capsule [Cometriq]) } Pack [Cometriq 140 MG Daily Dose Carton]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1363410", "drug_name": "{28 (cabozantinib 20 MG Oral Capsule [Cometriq]) / 28 (cabozantinib 80 MG Oral Capsule [Cometriq]) } Pack [Cometriq 100 MG Daily Dose Carton]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1364441", "drug_name": "apixaban 2.5 MG Oral Tablet [Eliquis]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1364447", "drug_name": "apixaban 5 MG Oral Tablet [Eliquis]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1364581", "drug_name": "{84 (cabozantinib 20 MG Oral Capsule [Cometriq]) } Pack [Cometriq 60 MG Daily Dose Carton]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1364848", "drug_name": "{21 (ethinyl estradiol 0.03 MG / levonorgestrel 0.15 MG Oral Tablet) / 7 (inert ingredients 1 MG Oral Tablet) } Pack [Chateal 28 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1364855", "drug_name": "ascorbic acid 60 MG / cholecalciferol 0.01 MG / folic acid 0.3 MG / niacin 13.5 MG / riboflavin 1.2 MG / sodium fluoride 2.2 MG / thiamine 1.05 MG / vitamin A 0.75 MG / vitamin B12 0.0045 MG / vitamin B6 1.05 MG / vitamin E 15 UNT Chewable Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1365653", "drug_name": "24 HR oxcarbazepine 150 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1365842", "drug_name": "24 HR oxcarbazepine 300 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1365844", "drug_name": "24 HR oxcarbazepine 600 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1365899", "drug_name": "{21 (ethinyl estradiol 0.035 MG / norgestimate 0.25 MG Oral Tablet) / 7 (inert ingredients 1 MG Oral Tablet) } Pack [Mono-Linyah 28 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1365980", "drug_name": "ascorbic acid 35 MG/ML / cholecalciferol 0.01 MG/ML / sodium fluoride 0.55 MG/ML / vitamin A palmitate 1500 UNT/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", 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"plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1370754", "drug_name": "hydrocortisone valerate 2 MG/ML Topical Cream", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1370758", "drug_name": "hydrocortisone butyrate 0.001 MG/MG Topical Ointment", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1370767", "drug_name": "hydrocortisone butyrate 1 MG/ML Topical Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1370770", "drug_name": "hydrocortisone butyrate 1 MG/ML Topical Cream", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1370982", "drug_name": "ospemifene 60 MG Oral Tablet [Osphena]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1373333", "drug_name": "isotretinoin 10 MG Oral Capsule [Zenatane]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1373335", "drug_name": "isotretinoin 20 MG Oral Capsule [Zenatane]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1373337", "drug_name": "isotretinoin 40 MG Oral Capsule [Zenatane]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1373483", "drug_name": "dimethyl fumarate 120 MG Delayed Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1373491", "drug_name": "dimethyl fumarate 240 MG Delayed Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1373497", "drug_name": "{14 (dimethyl fumarate 120 MG Delayed Release Oral Capsule) / 46 (dimethyl fumarate 240 MG Delayed Release Oral Capsule) } Pack", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1376336", "drug_name": "prednisolone acetate 10 MG/ML Ophthalmic Suspension", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "141868", "drug_name": "capsaicin 0.75 MG/ML Topical Cream", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "141935", "drug_name": "haloperidol 2 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "141963", "drug_name": "azithromycin 40 MG/ML Oral Suspension", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "141991", "drug_name": "ascorbic acid 200 MG Chewable Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "142004", "drug_name": "polyvinyl alcohol 0.014 ML/ML Ophthalmic Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "142034", "drug_name": "benzoyl peroxide 100 MG/ML Medicated Liquid Soap", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "142046", "drug_name": "metronidazole 0.0075 MG/MG Vaginal Gel", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1421461", "drug_name": "{24 (ethinyl estradiol 0.02 MG / norethindrone acetate 1 MG Oral Capsule) / 4 (ferrous fumarate 75 MG Oral Capsule) } Pack", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1422081", "drug_name": "{21 (desogestrel 0.15 MG / ethinyl estradiol 0.03 MG Oral Tablet) / 7 (inert ingredients 1 MG Oral Tablet) } Pack [Enskyce 28 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1422896", "drug_name": "{28 (norethindrone 0.35 MG Oral Tablet) } Pack [Jencycla 28 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1423123", "drug_name": "{7 (ethinyl estradiol 0.01 MG Oral Tablet) / 84 (ethinyl estradiol 0.03 MG / levonorgestrel 0.15 MG Oral Tablet) } Pack [Daysee 91 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1424889", "drug_name": "30 ACTUAT fluticasone furoate 0.1 MG/ACTUAT / vilanterol 0.025 MG/ACTUAT Dry Powder Inhaler", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1425110", "drug_name": "trametinib 0.5 MG Oral Tablet [Mekinist]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1425118", "drug_name": "trametinib 2 MG Oral Tablet [Mekinist]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1425181", "drug_name": "calcium carbonate 500 MG Chewable Tablet [Healthy Mama]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1425228", "drug_name": "dabrafenib 50 MG Oral Capsule [Tafinlar]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1425230", "drug_name": "dabrafenib 75 MG Oral Capsule [Tafinlar]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1425337", "drug_name": "dextroamphetamine sulfate 10 MG Oral Tablet [Zenzedi]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1425339", "drug_name": "dextroamphetamine sulfate 5 MG Oral Tablet [Zenzedi]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1426600", "drug_name": "{24 (ethinyl estradiol 0.02 MG / norethindrone acetate 1 MG Chewable Tablet) / 4 (ferrous fumarate 75 MG Oral Tablet) } Pack", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1426881", "drug_name": "levonorgestrel 1.5 MG Oral 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"step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1430453", "drug_name": "afatinib 30 MG Oral Tablet [Gilotrif]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1430457", "drug_name": "afatinib 40 MG Oral Tablet [Gilotrif]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1431083", "drug_name": "buprenorphine 1.4 MG / naloxone 0.36 MG Sublingual Tablet [Zubsolv]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1431104", "drug_name": "buprenorphine 5.7 MG / naloxone 1.4 MG Sublingual Tablet [Zubsolv]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1431235", "drug_name": "lurasidone hydrochloride 60 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1431971", "drug_name": "24 HR tacrolimus 0.5 MG Extended Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1431980", "drug_name": "24 HR tacrolimus 1 MG Extended Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1431985", "drug_name": "24 HR tacrolimus 5 MG Extended Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1432465", "drug_name": "calcium carbonate 1177 MG Chewable Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1433223", "drug_name": "24 HR levomilnacipran 120 MG Extended Release Oral Capsule [Fetzima]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1433229", "drug_name": "24 HR levomilnacipran 20 MG Extended Release Oral Capsule [Fetzima]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1433235", "drug_name": "24 HR levomilnacipran 40 MG Extended Release Oral Capsule [Fetzima]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1433241", "drug_name": "24 HR levomilnacipran 80 MG Extended Release Oral Capsule [Fetzima]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1433250", "drug_name": "{2 (24 HR levomilnacipran 20 MG Extended Release Oral Capsule [Fetzima]) / 26 (24 HR levomilnacipran 40 MG Extended Release Oral Capsule [Fetzima]) } Pack [Fetzima Pack]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1433879", "drug_name": "dolutegravir 50 MG Oral Tablet [Tivicay]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1435115", "drug_name": "28 ACTUAT teriparatide 0.02 MG/ACTUAT Pen Injector", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1436239", "drug_name": "24 HR topiramate 50 MG Extended Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1437278", "drug_name": "24 HR topiramate 25 MG Extended Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1437283", "drug_name": "24 HR topiramate 100 MG Extended Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1437288", "drug_name": "24 HR topiramate 200 MG Extended Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1437702", "drug_name": "albuterol 0.833 MG/ML / ipratropium bromide 0.167 MG/ML Inhalation Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1437968", "drug_name": "cyclophosphamide 25 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1437969", "drug_name": "cyclophosphamide 50 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1438778", "drug_name": "{21 (desogestrel 0.15 MG / ethinyl estradiol 0.02 MG Oral Tablet) / 5 (ethinyl estradiol 0.01 MG Oral Tablet) / 2 (inert ingredients 1 MG Oral Tablet) } Pack [Pimtrea Pack]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1440183", "drug_name": "{21 (ethinyl estradiol 0.02 MG / norethindrone acetate 1 MG Oral Tablet) / 7 (ferrous fumarate 75 MG Oral Tablet) } Pack [Larin Fe 1/20]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1440184", "drug_name": "hydrocortisone acetate 0.01 MG/MG Topical Ointment", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1440185", "drug_name": "{21 (ethinyl estradiol 0.02 MG / levonorgestrel 0.1 MG Oral Tablet) / 7 (inert ingredients 1 MG Oral Tablet) } Pack [Aubra 28 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1440936", "drug_name": "hydrocortisone 25 MG/ML Topical Cream [Proctozone HC]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1440937", "drug_name": "{21 (ethinyl estradiol 0.03 MG / norethindrone acetate 1.5 MG Oral Tablet) / 7 (ferrous fumarate 75 MG Oral Tablet) } Pack [Larin Fe 1.5/30]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1482507", "drug_name": "eslicarbazepine acetate 200 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1482515", "drug_name": "eslicarbazepine acetate 400 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1482521", "drug_name": "eslicarbazepine acetate 600 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1482525", "drug_name": "eslicarbazepine acetate 800 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1482533", "drug_name": "cetirizine hydrochloride 1 MG/ML Oral Solution [Wal Zyr 24 Hour Allergy]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1482814", "drug_name": "1 ML golimumab 100 MG/ML Prefilled Syringe [Simponi]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1483574", "drug_name": "docusate sodium 100 MG Oral Tablet [DOK]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1483617", "drug_name": "diphenhydramine hydrochloride 12.5 MG Disintegrating Oral Tablet [Wal-Dryl Allergy]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1483744", "drug_name": "naltrexone hydrochloride 50 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1485332", "drug_name": "{21 (ethinyl estradiol 0.035 MG / norethindrone 0.4 MG Oral Tablet) / 7 (inert ingredients 1 MG Oral Tablet) } Pack [Vyfemla 28 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"HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1486841", "drug_name": "raltegravir 100 MG Granules for Oral Suspension [Isentress]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1486846", "drug_name": "miconazole nitrate 0.02 MG/MG Topical Ointment [Aloe Vesta Antifungal]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1487086", "drug_name": "{21 (ethinyl estradiol 0.02 MG / norethindrone acetate 1 MG Oral Tablet) } Pack [Larin 1/20]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1487288", "drug_name": "acetaminophen 325 MG / oxycodone hydrochloride 2.5 MG Oral Tablet [Endocet]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1487361", "drug_name": "1 ML glatiramer acetate 40 MG/ML Prefilled Syringe", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1488353", "drug_name": "cholecalciferol 1.25 MG Oral Capsule [Decara]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1488569", "drug_name": "dapagliflozin 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1488574", "drug_name": "dapagliflozin 5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1490063", "drug_name": "levonorgestrel 1.5 MG Oral Tablet [Take Action]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1490065", "drug_name": "raloxifene hydrochloride 60 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1492742", "drug_name": "apremilast 20 MG Oral Tablet [Otezla]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1492746", "drug_name": "apremilast 30 MG Oral Tablet [Otezla]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1494769", "drug_name": "Sprinkle 24 HR topiramate 150 MG Extended Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1495092", "drug_name": "{28 (norethindrone 0.35 MG Oral Tablet) } Pack [Norlyroc 28 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "151029", "drug_name": "mometasone furoate 0.001 MG/MG Topical Ointment", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "151030", "drug_name": "mometasone furoate 1 MG/ML Topical Lotion", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "151226", "drug_name": "topiramate 50 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "152695", "drug_name": "meloxicam 15 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "152770", "drug_name": "calcium carbonate 1250 MG / cholecalciferol 0.01 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "153008", "drug_name": "ibuprofen 200 MG Oral Tablet [Advil]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1534809", "drug_name": "168 HR ethinyl estradiol 0.00146 MG/HR / norelgestromin 0.00625 MG/HR Transdermal System", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "153579", "drug_name": "progesterone 0.04 MG/MG Vaginal Gel [Crinone]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "153580", "drug_name": "progesterone 0.08 MG/MG Vaginal Gel [Crinone]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1536586", "drug_name": "168 HR 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"prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1539955", "drug_name": "{28 (norethindrone 0.35 MG Oral Tablet) } Pack [Sharobel 28 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1540356", "drug_name": "hydrocortisone 25 MG/ML Topical Cream [Proctosol]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1541890", "drug_name": "sunitinib 37.5 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": 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"BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1547231", "drug_name": "eliglustat 84 MG Oral Capsule [Cerdelga]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1547582", "drug_name": "0.5 ML Streptococcus pneumoniae type 1 capsular polysaccharide antigen 0.05 MG/ML / Streptococcus pneumoniae type 10A capsular polysaccharide antigen 0.05 MG/ML / Streptococcus pneumoniae type 11A capsular polysaccharide antigen 0.05 MG/ML / Streptococcus pneumoniae type 12F capsular polysaccharide antigen 0.05 MG/ML / Streptococcus pneumoniae type 14 capsular polysaccharide antigen 0.05 MG/ML / Streptococcus pneumoniae type 15B capsular polysaccharide antigen 0.05 MG/ML / Streptococcus pneumoniae type 17F capsular polysaccharide antigen 0.05 MG/ML / Streptococcus pneumoniae type 18C capsular polysaccharide antigen 0.05 MG/ML / Streptococcus pneumoniae type 19A capsular polysaccharide antigen 0.05 MG/ML / Streptococcus pneumoniae type 19F capsular polysaccharide antigen 0.05 MG/ML / Streptococcus pneumoniae type 2 capsular polysaccharide antigen 0.05 MG/ML / Streptococcus pneumoniae type 20 capsular polysaccharide antigen 0.05 MG/ML / Streptococcus pneumoniae type 22F capsular polysaccharide antigen 0.05 MG/ML / Streptococcus pneumoniae type 23F capsular polysaccharide antigen 0.05 MG/ML / Streptococcus pneumoniae type 3 capsular polysaccharide antigen 0.05 MG/ML / Streptococcus pneumoniae type 33F capsular polysaccharide antigen 0.05 MG/ML / Streptococcus pneumoniae type 4 capsular polysaccharide antigen 0.05 MG/ML / Streptococcus pneumoniae type 5 capsular polysaccharide antigen 0.05 MG/ML / Streptococcus pneumoniae type 6B capsular polysaccharide antigen 0.05 MG/ML / Streptococcus pneumoniae type 7F capsular polysaccharide antigen 0.05 MG/ML / Streptococcus pneumoniae type 8 capsular polysaccharide antigen 0.05 MG/ML / Streptococcus pneumoniae type 9N capsular polysaccharide antigen 0.05 MG/ML / Streptococcus pneumoniae type 9V capsular polysaccharide antigen 0.05 MG/ML Prefilled Syringe [Pneumovax 23]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1549091", "drug_name": "levonorgestrel 1.5 MG Oral Tablet [Opcicon One-Step]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1549337", "drug_name": "cetirizine hydrochloride 10 MG Oral Capsule [Wal-Zyr]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1549683", "drug_name": "{42 (rivaroxaban 15 MG Oral Tablet [Xarelto]) / 9 (rivaroxaban 20 MG Oral Tablet [Xarelto]) } Pack [Xarelto Kit]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1550536", "drug_name": "{21 (ethinyl estradiol 0.02 MG / norethindrone acetate 1 MG Oral Tablet) / 7 (ferrous fumarate 75 MG Oral Tablet) } Pack [Tarina Fe 1/20 28 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1592279", "drug_name": "pirfenidone 267 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1593058", "drug_name": "24 HR dapagliflozin 10 MG / metformin hydrochloride 1000 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1593068", "drug_name": "24 HR dapagliflozin 10 MG / metformin hydrochloride 500 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1593070", "drug_name": "24 HR dapagliflozin 5 MG / metformin hydrochloride 1000 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1593072", "drug_name": "24 HR dapagliflozin 5 MG / metformin hydrochloride 500 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1593876", "drug_name": "sodium chloride 6.5 MG/ML Nasal Spray [Altamist]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1594673", "drug_name": "amylase 105000 UNT / lipase 25000 UNT / protease 79000 UNT Delayed Release Oral Capsule [Zenpep]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1594962", "drug_name": "mineral oil 45 MG/ML / mineral oil, light 10 MG/ML Ophthalmic Solution [Soothe Mineral Oil]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1595292", "drug_name": "amylase 14000 UNT / lipase 3000 UNT / protease 10000 UNT Delayed Release Oral Capsule [Zenpep]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1595457", "drug_name": "amylase 24000 UNT / lipase 5000 UNT / protease 17000 UNT Delayed Release Oral Capsule [Zenpep]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1595462", "drug_name": "amylase 42000 UNT / lipase 10000 UNT / protease 32000 UNT Delayed Release Oral Capsule [Zenpep]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1595473", "drug_name": "amylase 63000 UNT / lipase 15000 UNT / protease 47000 UNT Delayed Release Oral Capsule [Zenpep]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1595478", "drug_name": "amylase 84000 UNT / lipase 20000 UNT / protease 63000 UNT Delayed Release Oral Capsule [Zenpep]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1596779", "drug_name": "14 ACTUAT budesonide 2 MG/ACTUAT Rectal Foam", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1597099", "drug_name": "0.5 ML L1 protein, human papillomavirus type 11 vaccine 0.08 MG/ML / L1 protein, human papillomavirus type 16 vaccine 0.12 MG/ML / L1 protein, human papillomavirus type 18 vaccine 0.08 MG/ML / L1 protein, human papillomavirus type 31 vaccine 0.04 MG/ML / L1 protein, human papillomavirus type 33 vaccine 0.04 MG/ML / L1 protein, human papillomavirus type 45 vaccine 0.04 MG/ML / L1 protein, human papillomavirus type 52 vaccine 0.04 MG/ML / L1 protein, human papillomavirus type 58 vaccine 0.04 MG/ML / L1 protein, human papillomavirus type 6 vaccine 0.06 MG/ML 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false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1597123", "drug_name": "2500 MG testosterone 0.01 MG/MG Topical Gel", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1597570", "drug_name": "buprenorphine 11.4 MG / naloxone 2.9 MG Sublingual Tablet [Zubsolv]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1597575", "drug_name": "buprenorphine 8.6 MG / naloxone 2.1 MG Sublingual Tablet [Zubsolv]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1597814", "drug_name": "nonoxynol-9 0.04 MG/MG Vaginal Gel [VCF Contraceptive]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1598658", "drug_name": "levonorgestrel 1.5 MG Oral Tablet [Aftera]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1598989", "drug_name": "atazanavir 50 MG Oral Powder [Reyataz]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1600602", "drug_name": "levonorgestrel 1.5 MG Oral Tablet [EContra]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1600710", "drug_name": "cobicistat 150 MG / darunavir 800 MG Oral Tablet [Prezcobix]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1601086", "drug_name": "olopatadine 7 MG/ML Ophthalmic Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1601660", "drug_name": "atazanavir 300 MG / cobicistat 150 MG Oral Tablet [Evotaz]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1602604", "drug_name": "1.5 ML aripiprazole 200 MG/ML Prefilled Syringe [Abilify]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1602607", "drug_name": "2 ML aripiprazole 200 MG/ML Prefilled Syringe [Abilify]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1603466", "drug_name": "carboxymethylcellulose sodium 5 MG/ML Ophthalmic Solution [Eyes Alive Lubricating]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1603861", "drug_name": "{7 (ethinyl estradiol 0.01 MG Oral Tablet) / 84 (ethinyl estradiol 0.03 MG / levonorgestrel 0.15 MG Oral Tablet) } Pack [Ashlyna 91 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1604350", "drug_name": "{30 (lenvatinib 10 MG Oral Capsule [Lenvima]) / 30 (lenvatinib 4 MG Oral Capsule [Lenvima]) } Pack [Lenvima 14]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1604352", "drug_name": "{60 (lenvatinib 10 MG Oral Capsule [Lenvima]) / 30 (lenvatinib 4 MG Oral Capsule [Lenvima]) } Pack [Lenvima 24]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1604384", "drug_name": "{30 (lenvatinib 10 MG Oral Capsule [Lenvima]) } Pack [Lenvima 10]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1604395", "drug_name": "{60 (lenvatinib 10 MG Oral Capsule [Lenvima]) } Pack [Lenvima 20]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1605086", "drug_name": "{21 (desogestrel 0.15 MG / ethinyl estradiol 0.03 MG Oral Tablet) / 7 (inert ingredients 1 MG Oral Tablet) } Pack [Juleber 28 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1605088", "drug_name": "isotretinoin 30 MG Oral Capsule [Zenatane]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1605091", "drug_name": "{24 (ethinyl estradiol 0.02 MG / norethindrone acetate 1 MG Oral Tablet) / 4 (ferrous fumarate 75 MG Oral Tablet) } Pack [Larin 24 Fe 1/20]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1605368", "drug_name": "24 HR levetiracetam 1000 MG Extended Release Oral Tablet [Elepsia]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1605374", "drug_name": "24 HR levetiracetam 1500 MG Extended Release Oral Tablet [Elepsia]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1605455", "drug_name": "{4 (apremilast 10 MG Oral Tablet [Otezla]) / 4 (apremilast 20 MG Oral Tablet [Otezla]) / 47 (apremilast 30 MG Oral Tablet [Otezla]) } Pack [Otezla 28-Day 10/20/30 Starter Pack]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1606337", "drug_name": "asenapine 2.5 MG Sublingual Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1606850", "drug_name": "guaifenesin 20 MG/ML Oral Suspension", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1606866", "drug_name": "ivacaftor 50 MG Oral Granules [Kalydeco]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1606870", "drug_name": "ivacaftor 75 MG Oral Granules [Kalydeco]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1607617", "drug_name": "24 HR desvenlafaxine succinate 25 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1607784", "drug_name": "deferasirox 180 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1607792", "drug_name": "deferasirox 360 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1607796", "drug_name": "deferasirox 90 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1648110", "drug_name": "bacitracin 0.5 UNT/MG Topical Ointment", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1648755", "drug_name": "nitrofurantoin, macrocrystals 25 MG / nitrofurantoin, monohydrate 75 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1648759", "drug_name": "nitrofurantoin, macrocrystals 100 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1648788", "drug_name": "30 ACTUAT fluticasone furoate 0.2 MG/ACTUAT / vilanterol 0.025 MG/ACTUAT Dry Powder 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"step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1649493", "drug_name": "ivabradine 7.5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1649961", "drug_name": "200 ACTUAT albuterol 0.09 MG/ACTUAT Dry Powder Inhaler [ProAir]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": true, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1649988", "drug_name": "doxycycline hyclate 100 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1649996", "drug_name": "0.5 ML interferon beta-1a 0.044 MG/ML Auto-Injector [Rebif]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1650004", "drug_name": "0.5 ML interferon beta-1a 0.088 MG/ML Auto-Injector [Rebif]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1650030", "drug_name": "doxycycline monohydrate 5 MG/ML Oral Suspension", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1650143", "drug_name": "doxycycline hyclate 100 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1650274", "drug_name": "cholecalciferol 0.375 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1650282", "drug_name": "{6 (0.2 ML interferon beta-1a 0.044 MG/ML Auto-Injector [Rebif]) / 6 (0.5 ML interferon beta-1a 0.044 MG/ML Auto-Injector [Rebif]) } Pack [Rebif Rebidose]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1650901", "drug_name": "0.5 ML interferon beta-1a 0.06 MG/ML Auto-Injector [Avonex]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1650968", "drug_name": "0.88 ML paliperidone palmitate 310 MG/ML Prefilled Syringe [Invega]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1650972", "drug_name": "1.32 ML paliperidone palmitate 311 MG/ML Prefilled Syringe [Invega]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1650974", "drug_name": "1.75 ML paliperidone palmitate 312 MG/ML Prefilled Syringe [Invega]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1650976", "drug_name": "2.63 ML paliperidone palmitate 311 MG/ML Prefilled Syringe [Invega]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1652084", "drug_name": "{24 (ethinyl estradiol 0.02 MG / norethindrone acetate 1 MG Oral Tablet) / 4 (ferrous fumarate 75 MG Oral Tablet) } Pack [Junel Fe 24 1/20 28 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1652640", "drug_name": "3 ML insulin lispro 100 UNT/ML Pen Injector [Humalog]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1652646", "drug_name": "3 ML insulin lispro 100 UNT/ML Cartridge [Humalog]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1653049", "drug_name": "calcium carbonate 1177 MG Chewable Tablet [Tums]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1653144", "drug_name": "0.5 ML golimumab 100 MG/ML Auto-Injector [Simponi]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1653166", "drug_name": "1 ML golimumab 100 MG/ML Auto-Injector [Simponi]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1653198", "drug_name": "3 ML insulin aspart, human 100 UNT/ML Cartridge [NovoLog]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1653204", "drug_name": "3 ML insulin aspart, human 100 UNT/ML Pen Injector [NovoLog]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1653217", "drug_name": "sapropterin dihydrochloride 500 MG Powder for Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1653225", "drug_name": "1 ML etanercept 50 MG/ML Auto-Injector [Enbrel]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1654630", "drug_name": "1 ML glatiramer acetate 20 MG/ML Prefilled Syringe [Glatopa]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1655934", "drug_name": "ivacaftor 125 MG / lumacaftor 200 MG Oral Tablet [ORKAMBI]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1656327", "drug_name": "lidocaine 25 MG/ML / prilocaine 25 MG/ML Topical Cream [Relador]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1656340", "drug_name": "sacubitril 24 MG / valsartan 26 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1656349", "drug_name": "sacubitril 49 MG / valsartan 51 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1656354", "drug_name": "sacubitril 97 MG / valsartan 103 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1657151", "drug_name": "0.5 ML sumatriptan 12 MG/ML Auto-Injector", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1657212", "drug_name": "omalizumab 150 MG Injection [Xolair]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1658102", "drug_name": "1 ML hepatitis A virus strain CR 326F antigen, inactivated 50 UNT/ML Injection [Vaqta]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1658106", "drug_name": "0.5 ML hepatitis A virus strain CR 326F antigen, inactivated 50 UNT/ML Injection [Vaqta]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1658150", "drug_name": "1 ML hepatitis B surface antigen vaccine 0.01 MG/ML Injection [Recombivax]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1658155", "drug_name": "0.5 ML hepatitis B surface antigen vaccine 0.01 MG/ML Injection [Recombivax]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, 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"22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1736045", "drug_name": "levetiracetam 250 MG Tablet for Oral Suspension", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1736048", "drug_name": "levetiracetam 500 MG Tablet for Oral Suspension", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1736654", "drug_name": "ethinyl estradiol 0.0025 MG / norethindrone acetate 0.5 MG Oral Tablet [Fyavolv]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1736656", "drug_name": "ethinyl estradiol 0.005 MG / norethindrone acetate 1 MG Oral Tablet [Fyavolv]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1737778", "drug_name": "lidocaine 0.04 MG/MG Medicated Patch", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1737789", "drug_name": "mebendazole 100 MG Chewable Tablet [Emverm]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1738483", "drug_name": "paroxetine hydrochloride 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1738495", "drug_name": "paroxetine hydrochloride 20 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1738503", "drug_name": "paroxetine hydrochloride 30 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1738511", "drug_name": "paroxetine hydrochloride 40 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1738803", "drug_name": "24 HR paroxetine hydrochloride 12.5 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1738805", "drug_name": "24 HR paroxetine hydrochloride 25 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1738807", "drug_name": "24 HR paroxetine hydrochloride 37.5 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1739749", "drug_name": "5 ML brivaracetam 10 MG/ML Injection", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1739761", "drug_name": "brivaracetam 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1739768", "drug_name": "brivaracetam 100 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1739772", "drug_name": "brivaracetam 25 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1739776", "drug_name": "brivaracetam 50 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1739780", "drug_name": "brivaracetam 75 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1739785", "drug_name": "brivaracetam 10 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1739800", "drug_name": "uridine triacetate 10000 MG Oral Granules [Vistogard]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1741046", "drug_name": "24 HR tofacitinib 11 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1741417", "drug_name": "cholecalciferol 10000 UNT / menatetrenone 0.1 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1741739", "drug_name": "emtricitabine 200 MG / rilpivirine 25 MG / tenofovir alafenamide 25 MG Oral Tablet [Odefsey]", "plans": 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"drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1744009", "drug_name": "emtricitabine 167 MG / tenofovir disoproxil fumarate 250 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1745091", "drug_name": "lidocaine 0.05 MG/MG Medicated Patch", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1746494", "drug_name": "cholecalciferol 0.125 MG Disintegrating Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1747567", "drug_name": "venetoclax 100 MG Oral Tablet [Venclexta]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1747577", "drug_name": "venetoclax 10 MG Oral Tablet [Venclexta]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1747579", "drug_name": "venetoclax 50 MG Oral Tablet [Venclexta]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1747580", "drug_name": "{14 (venetoclax 10 MG Oral Tablet [Venclexta]) / 21 (venetoclax 100 MG Oral Tablet [Venclexta]) / 7 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"HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1790167", "drug_name": "cabozantinib 20 MG Oral Tablet [Cabometyx]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1790171", "drug_name": "cabozantinib 40 MG Oral Tablet [Cabometyx]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1790175", "drug_name": "cabozantinib 60 MG Oral Tablet [Cabometyx]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1790644", "drug_name": "120 ACTUAT formoterol fumarate 0.0048 MG/ACTUAT / glycopyrrolate 0.009 MG/ACTUAT Metered Dose Inhaler [Bevespi]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1790684", "drug_name": "hydrocortisone 25 MG/ML Topical Cream [Procto-Med]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1790886", "drug_name": "vortioxetine 10 MG Oral Tablet [Trintellix]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1790890", "drug_name": "vortioxetine 20 MG Oral Tablet [Trintellix]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1790892", "drug_name": "vortioxetine 5 MG Oral Tablet [Trintellix]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1792393", "drug_name": "{30 (lenvatinib 10 MG Oral Capsule [Lenvima]) / 60 (lenvatinib 4 MG Oral Capsule [Lenvima]) } Pack [Lenvima 18]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1794552", "drug_name": "2 ML hydroxyzine hydrochloride 50 MG/ML Injection", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1794554", "drug_name": "1 ML hydroxyzine hydrochloride 50 MG/ML Injection", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1796665", "drug_name": "{60 (lenvatinib 4 MG Oral Capsule [Lenvima]) } Pack [Lenvima 8]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1797113", "drug_name": "estradiol 0.01 MG Vaginal Insert [Yuvafem]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1797833", "drug_name": "ipratropium bromide 0.021 MG/ACTUAT Metered Dose Nasal Spray", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1797844", "drug_name": "ipratropium bromide 0.042 MG/ACTUAT Metered Dose Nasal Spray", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1797851", "drug_name": "cromolyn sodium 5.2 MG/ACTUAT Metered Dose Nasal Spray", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1797863", "drug_name": "flunisolide 0.025 MG/ACTUAT Metered Dose Nasal Spray", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1797867", "drug_name": "azelastine hydrochloride 0.137 MG/ACTUAT Metered Dose Nasal Spray", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1797880", "drug_name": "nafarelin 0.2 MG/ACTUAT Metered Dose Nasal Spray [Synarel]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1797884", "drug_name": "azelastine hydrochloride 0.206 MG/ACTUAT Metered Dose Nasal Spray [Astepro]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1797888", "drug_name": "nicotine 0.5 MG/ACTUAT Metered Dose Nasal Spray [Nicotrol]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1797907", "drug_name": "fluticasone propionate 0.05 MG/ACTUAT Metered Dose Nasal Spray", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1797909", "drug_name": "fluticasone propionate 0.05 MG/ACTUAT Metered Dose Nasal Spray [Aller-Flo]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1797913", "drug_name": "triamcinolone acetonide 0.055 MG/ACTUAT Metered Dose Nasal Spray", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1797915", "drug_name": "triamcinolone acetonide 0.055 MG/ACTUAT Metered Dose Nasal Spray [Nasacort]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1797929", "drug_name": "budesonide 0.032 MG/ACTUAT Metered Dose Nasal Spray", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1797933", "drug_name": "fluticasone propionate 0.05 MG/ACTUAT Metered Dose Nasal Spray [Flonase]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1799178", "drug_name": "ascorbic acid 125 MG / iron carbonyl 65 MG Delayed Release Oral Tablet [Vitron-C Reformulated Jul 2016]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1799212", "drug_name": "sofosbuvir 400 MG / velpatasvir 100 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1799654", "drug_name": "sodium polystyrene sulfonate 250 MG/ML Oral Suspension [SPS]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1800499", "drug_name": "{21 (ethinyl estradiol 0.035 MG / norgestimate 0.25 MG Oral Tablet) / 7 (inert ingredients 1 MG Oral Tablet) } Pack [Mili 28 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1800500", "drug_name": "{7 (ethinyl estradiol 0.035 MG / norgestimate 0.18 MG Oral Tablet) / 7 (ethinyl estradiol 0.035 MG / norgestimate 0.215 MG Oral Tablet) / 7 (ethinyl estradiol 0.035 MG / norgestimate 0.25 MG Oral Tablet) / 7 (inert ingredients 1 MG Oral Tablet) } Pack [Tri-Mili 28 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1801279", "drug_name": "Sugar-Free cholestyramine resin 4000 MG Powder for Oral Suspension", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1801289", "drug_name": "Smoking Cessation 12 HR bupropion hydrochloride 150 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1801294", "drug_name": "Microencapsulated potassium chloride 20 MEQ Extended Release Oral Tablet", "plans": [ { 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"HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1806177", "drug_name": "50/50 Release 24 HR methylphenidate hydrochloride 20 MG Extended Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1806179", "drug_name": "50/50 Release 24 HR methylphenidate hydrochloride 30 MG Extended Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1806181", "drug_name": "30/70 Release 24 HR methylphenidate hydrochloride 10 MG Extended Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1806183", "drug_name": "50/50 Release 24 HR methylphenidate hydrochloride 40 MG Extended Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1806187", "drug_name": "30/70 Release 24 HR methylphenidate hydrochloride 20 MG Extended Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1806189", "drug_name": "30/70 Release 24 HR methylphenidate hydrochloride 30 MG Extended Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", 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"22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1807459", "drug_name": "2 ML diazepam 5 MG/ML Cartridge", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1811180", "drug_name": "icosapent ethyl 500 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1812011", "drug_name": "Osmotic 24 HR nifedipine 30 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1812013", "drug_name": "Osmotic 24 HR nifedipine 60 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1812015", "drug_name": "Osmotic 24 HR nifedipine 90 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1812279", "drug_name": "{21 (ethinyl estradiol 0.03 MG / levonorgestrel 0.15 MG Oral Tablet) / 7 (inert ingredients 1 MG Oral Tablet) } Pack [Ayuna 28 Day Pack]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1812419", "drug_name": "Sprinkle 24 HR topiramate 200 MG Extended Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1812421", "drug_name": "Sprinkle 24 HR topiramate 25 MG Extended Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1812425", "drug_name": "Sprinkle 24 HR topiramate 50 MG Extended Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1812427", "drug_name": "Sprinkle 24 HR topiramate 100 MG Extended Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1812470", "drug_name": "ivacaftor 125 MG / lumacaftor 100 MG Oral Tablet [ORKAMBI]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1855519", "drug_name": "levonorgestrel 1.5 MG Oral Tablet [Her Style]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1856402", "drug_name": "{21 (ethinyl estradiol 0.035 MG / norethindrone 1 MG Oral Tablet) / 7 (inert ingredients 1 MG Oral Tablet) } Pack [Nylia 1/35 28 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1856424", "drug_name": "{7 (ethinyl estradiol 0.035 MG / norethindrone 0.5 MG Oral Tablet) / 7 (ethinyl estradiol 0.035 MG / norethindrone 0.75 MG Oral Tablet) / 7 (ethinyl estradiol 0.035 MG / norethindrone 1 MG Oral Tablet) / 7 (inert ingredients 1 MG Oral Tablet) } Pack [Nylia 7/7/7 28 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1858836", "drug_name": "{7 (ethinyl estradiol 0.025 MG / norgestimate 0.18 MG Oral Tablet) / 7 (ethinyl estradiol 0.025 MG / norgestimate 0.215 MG Oral Tablet) / 7 (ethinyl estradiol 0.025 MG / norgestimate 0.25 MG Oral Tablet) / 7 (inert ingredients 1 MG Oral Tablet) } Pack [Tri-Lo-Mili]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1859000", "drug_name": "3 ML insulin glargine 100 UNT/ML / lixisenatide 0.033 MG/ML Pen Injector [Soliqua]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": true, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1860100", "drug_name": "ferrous sulfate 324 MG Delayed Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1860414", "drug_name": "{21 (ethinyl estradiol 0.02 MG / levonorgestrel 0.1 MG Oral Tablet) / 7 (inert ingredients 1 MG Oral Tablet) } Pack [Afirmelle 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false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1864414", "drug_name": "buprenorphine 0.7 MG / naloxone 0.18 MG Sublingual Tablet [Zubsolv]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1865962", "drug_name": "crisaborole 0.02 MG/MG Topical Ointment [Eucrisa]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": true, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1866047", "drug_name": "{21 (desogestrel 0.15 MG / ethinyl estradiol 0.03 MG Oral Tablet) / 7 (inert ingredients 1 MG Oral Tablet) } Pack [Isibloom 28 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1868014", "drug_name": "pirfenidone 267 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1868018", "drug_name": "pirfenidone 801 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1869684", "drug_name": "glutamine 5000 MG Powder for Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1869699", "drug_name": "linaclotide 0.072 MG Oral Capsule [Linzess]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1870207", "drug_name": "NDA019430 0.3 ML epinephrine 1 MG/ML Auto-Injector", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1870225", "drug_name": "NDA020800 0.15 ML epinephrine 1 MG/ML Auto-Injector", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1870230", "drug_name": "NDA020800 0.3 ML epinephrine 1 MG/ML Auto-Injector", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1872920", "drug_name": "docusate sodium 50 MG / sennosides, USP 8.6 MG Oral Tablet [Colace w/Sennosides]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1873704", "drug_name": "{24 (ethinyl estradiol 0.02 MG / norethindrone acetate 1 MG Chewable Tablet) / 4 (ferrous fumarate 75 MG Oral Tablet) } Pack [Mibelas 24 Fe Chewable 28 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1874553", "drug_name": "24 HR desvenlafaxine succinate 100 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1874559", "drug_name": "24 HR desvenlafaxine succinate 50 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1874857", "drug_name": "calcium citrate 1500 MG / cholecalciferol 200 UNT Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1876397", "drug_name": "{7 (ethinyl estradiol 0.01 MG Oral Tablet) / 42 (ethinyl estradiol 0.02 MG / levonorgestrel 0.15 MG Oral Tablet) / 21 (ethinyl estradiol 0.025 MG / levonorgestrel 0.15 MG Oral Tablet) / 21 (ethinyl estradiol 0.03 MG / levonorgestrel 0.15 MG Oral Tablet) } Pack [Rivelsa 91 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1876810", "drug_name": "{21 (desogestrel 0.15 MG / ethinyl estradiol 0.02 MG Oral Tablet) / 5 (ethinyl estradiol 0.01 MG Oral Tablet) / 2 (inert ingredients 1 MG Oral Tablet) } Pack [Simliya 28 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1876916", "drug_name": "deutetrabenazine 12 MG Oral Tablet [Austedo]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1876920", "drug_name": "deutetrabenazine 6 MG Oral Tablet [Austedo]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1876924", "drug_name": "deutetrabenazine 9 MG Oral Tablet [Austedo]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1918056", "drug_name": "{7 (ethinyl estradiol 0.01 MG Oral Tablet) / 84 (ethinyl estradiol 0.03 MG / levonorgestrel 0.15 MG Oral Tablet) } Pack [Simpesse 91 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1918230", "drug_name": "valbenazine 40 MG Oral Capsule [Ingrezza]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1919094", "drug_name": "midostaurin 25 MG Oral Capsule [Rydapt]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1921589", "drug_name": "rucaparib 250 MG Oral Tablet [Rubraca]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1922720", "drug_name": "Atrial Fibrillation sotalol hydrochloride 120 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1922759", "drug_name": "levonorgestrel 1.5 MG Oral Tablet [My Choice]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1922763", "drug_name": "Atrial Fibrillation sotalol hydrochloride 160 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1922765", "drug_name": "Atrial Fibrillation sotalol hydrochloride 80 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1923421", "drug_name": "{21 (desogestrel 0.15 MG / ethinyl estradiol 0.03 MG Oral Tablet) / 7 (inert ingredients 1 MG Oral Tablet) } Pack [Kalliga 28 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1923422", "drug_name": "sotalol hydrochloride 120 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1923424", "drug_name": "sotalol hydrochloride 160 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1923426", "drug_name": "sotalol hydrochloride 80 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1923428", "drug_name": "timolol 2.5 MG/ML Ophthalmic Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1923432", "drug_name": "dorzolamide 20 MG/ML / timolol 5 MG/ML Ophthalmic Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1923822", "drug_name": "deferasirox 90 MG Oral Granules", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1923826", "drug_name": "deferasirox 360 MG Oral Granules", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1923828", "drug_name": "deferasirox 180 MG Oral Granules", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1924315", "drug_name": "raltegravir 600 MG Oral Tablet [Isentress]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1925264", "drug_name": "3.9 ML aripiprazole lauroxil 273 MG/ML Prefilled Syringe [Aristada]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1926069", "drug_name": "ritonavir 100 MG Oral Powder [Norvir]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1926332", "drug_name": "0.5 UNT Doses 3 ML insulin lispro 100 UNT/ML Pen Injector [Humalog]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1926946", "drug_name": "{21 (ethinyl estradiol 0.02 MG / norethindrone acetate 1 MG Oral Tablet) / 7 (ferrous fumarate 75 MG Oral Tablet) } Pack [Aurovela Fe 1/20 28 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1927366", "drug_name": "{21 (ethinyl estradiol 0.02 MG / norethindrone acetate 1 MG Oral Tablet) } Pack [Aurovela 1/20 21 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1927957", "drug_name": "{24 (ethinyl estradiol 0.02 MG / norethindrone acetate 1 MG Oral Tablet) / 4 (ferrous fumarate 75 MG Oral Tablet) } Pack [Aurovela Fe 24 1/20 28 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1928007", "drug_name": "{21 (ethinyl estradiol 0.03 MG / norethindrone acetate 1.5 MG Oral Tablet) } Pack [Aurovela 1.5/30 21 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1940372", "drug_name": "enasidenib 100 MG Oral Tablet [Idhifa]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1940376", "drug_name": "enasidenib 50 MG Oral Tablet [Idhifa]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1940709", "drug_name": "glecaprevir 100 MG / pibrentasvir 40 MG Oral Tablet [Mavyret]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1941470", "drug_name": "nitisinone 10 MG Oral Tablet [Nityr]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1941473", "drug_name": "nitisinone 5 MG Oral Tablet [Nityr]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1941476", "drug_name": "nitisinone 2 MG Oral Tablet [Nityr]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1945044", "drug_name": "14 ACTUAT fluticasone furoate 0.1 MG/ACTUAT / umeclidinium 0.0625 MG/ACTUAT / vilanterol 0.025 MG/ACTUAT Dry Powder Inhaler [Trelegy]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1945048", "drug_name": "30 ACTUAT fluticasone furoate 0.1 MG/ACTUAT / umeclidinium 0.0625 MG/ACTUAT / vilanterol 0.025 MG/ACTUAT Dry Powder Inhaler [Trelegy]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1946525", "drug_name": "Matrix Delivery 24 HR tramadol hydrochloride 300 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": true, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1946836", "drug_name": "abemaciclib 50 MG Oral Tablet [Verzenio]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1946840", "drug_name": "abemaciclib 100 MG Oral Tablet [Verzenio]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1946844", "drug_name": "abemaciclib 150 MG Oral Tablet [Verzenio]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1946848", "drug_name": "abemaciclib 200 MG Oral Tablet [Verzenio]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197303", "drug_name": "acetazolamide 125 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197304", "drug_name": "acetazolamide 250 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197305", "drug_name": "acetic acid 20 MG/ML Otic Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197310", "drug_name": "acyclovir 200 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197311", "drug_name": "acyclovir 400 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197313", "drug_name": "acyclovir 800 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197316", "drug_name": "albuterol 2 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197318", "drug_name": "albuterol 4 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197319", "drug_name": "allopurinol 100 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197320", "drug_name": "allopurinol 300 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197321", "drug_name": "alprazolam 1 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197322", "drug_name": "alprazolam 2 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197351", "drug_name": "6-aminocaproic acid 500 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197361", "drug_name": "amlodipine 5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197362", "drug_name": "ammonium lactate 120 MG/ML Topical Lotion", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197363", "drug_name": "amoxapine 100 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197364", "drug_name": "amoxapine 150 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197365", "drug_name": "amoxapine 25 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197366", "drug_name": "amoxapine 50 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197379", "drug_name": "atenolol 100 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197380", "drug_name": "atenolol 25 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197381", "drug_name": "atenolol 50 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197382", "drug_name": "atenolol 100 MG / chlorthalidone 25 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197383", "drug_name": "atenolol 50 MG / chlorthalidone 25 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197388", "drug_name": "azathioprine 50 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197391", "drug_name": "baclofen 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197392", "drug_name": "baclofen 20 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197397", "drug_name": "benzonatate 100 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197405", "drug_name": "betamethasone 0.0005 MG/MG Topical Ointment", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "197407", "drug_name": "betamethasone 1 MG/ML Topical Cream", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "197408", "drug_name": "betamethasone 1 MG/ML Topical Lotion", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "197409", "drug_name": "betamethasone 0.001 MG/MG Topical Ointment", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "197411", "drug_name": "bromocriptine 2.5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197412", "drug_name": "bromocriptine 5 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197417", "drug_name": "bumetanide 0.5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197418", "drug_name": "bumetanide 1 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197419", "drug_name": "bumetanide 2 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197442", "drug_name": "carbamazepine 200 MG Chewable Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197443", "drug_name": "carbidopa 10 MG / levodopa 100 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197444", "drug_name": "carbidopa 25 MG / levodopa 100 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197445", "drug_name": "carbidopa 25 MG / levodopa 250 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197446", "drug_name": "carisoprodol 350 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "197448", "drug_name": "levocarnitine 330 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197452", "drug_name": "cefprozil 250 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197453", "drug_name": "cefprozil 500 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197454", "drug_name": "cephalexin 500 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197464", "drug_name": "clorazepate dipotassium 15 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197465", "drug_name": "clorazepate dipotassium 3.75 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197466", "drug_name": "clorazepate dipotassium 7.5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197499", "drug_name": "chlorthalidone 25 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197500", "drug_name": "chlorthalidone 50 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197502", "drug_name": "chlorzoxazone 500 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197505", "drug_name": "cimetidine 200 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197506", "drug_name": "cimetidine 300 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197507", "drug_name": "cimetidine 400 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197508", "drug_name": "cimetidine 800 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197511", "drug_name": "ciprofloxacin 250 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197512", "drug_name": "ciprofloxacin 750 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197516", "drug_name": "clarithromycin 250 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197517", "drug_name": "clarithromycin 500 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197518", "drug_name": "clindamycin 150 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197519", "drug_name": "clindamycin 10 MG/ML Topical Lotion", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "197527", "drug_name": "clonazepam 0.5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197528", "drug_name": "clonazepam 1 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197529", "drug_name": "clonazepam 2 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197535", "drug_name": "clozapine 100 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197536", "drug_name": "clozapine 25 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197541", "drug_name": "colchicine 0.6 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "197553", "drug_name": "cyclosporine 25 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197554", "drug_name": "danazol 100 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197555", "drug_name": "danazol 200 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197556", "drug_name": "danazol 50 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197557", "drug_name": "dapsone 100 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197558", "drug_name": "dapsone 25 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197572", "drug_name": "desonide 0.5 MG/ML Topical Lotion", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "197573", "drug_name": "desoximetasone 0.5 MG/ML Topical Cream", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "197574", "drug_name": "desoximetasone 2.5 MG/ML Topical Cream", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "197575", "drug_name": "desoximetasone 0.0025 MG/MG Topical Ointment", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "197577", "drug_name": "dexamethasone 0.5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197579", "drug_name": "dexamethasone 1 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197580", "drug_name": "dexamethasone 1.5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197581", "drug_name": "dexamethasone 2 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197582", "drug_name": "dexamethasone 4 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197583", "drug_name": "dexamethasone 6 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197589", "drug_name": "diazepam 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "197590", "drug_name": "diazepam 2 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "197591", "drug_name": "diazepam 5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "197595", "drug_name": "dicloxacillin 250 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197596", "drug_name": "dicloxacillin 500 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197603", "drug_name": "diflunisal 500 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197604", "drug_name": "digoxin 0.125 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "197606", "drug_name": "digoxin 0.25 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "197622", "drug_name": "dipyridamole 50 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197623", "drug_name": "disulfiram 250 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197624", "drug_name": "disulfiram 500 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197625", "drug_name": "doxazosin 1 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197626", "drug_name": "doxazosin 2 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197627", "drug_name": "doxazosin 4 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197628", "drug_name": "doxazosin 8 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197634", "drug_name": "dronabinol 10 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "197635", "drug_name": "dronabinol 2.5 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "197636", "drug_name": "dronabinol 5 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "197650", "drug_name": "erythromycin 500 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197657", "drug_name": "estradiol 0.5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197658", "drug_name": "estradiol 1 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197659", "drug_name": "estradiol 2 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197682", "drug_name": "ethosuximide 250 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197684", "drug_name": "etodolac 200 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197685", "drug_name": "etodolac 300 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197686", "drug_name": "etodolac 400 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197687", "drug_name": "etoposide 50 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197696", "drug_name": "72 HR fentanyl 0.075 MG/HR Transdermal System", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": true, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "197698", "drug_name": "fluconazole 100 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197699", "drug_name": "fluconazole 150 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197700", "drug_name": "fluconazole 200 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197701", "drug_name": "fluconazole 50 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197730", "drug_name": "furosemide 10 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197732", "drug_name": "furosemide 80 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197735", "drug_name": "gentamicin 1 MG/ML Topical Cream", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197738", "drug_name": "glycopyrrolate 1 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197739", "drug_name": "glycopyrrolate 2 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197741", "drug_name": "guaifenesin 200 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197745", "drug_name": "guanfacine 1 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197746", "drug_name": "guanfacine 2 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197754", "drug_name": "haloperidol 20 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197770", "drug_name": "hydrochlorothiazide 50 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197782", "drug_name": "hydrocortisone 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197783", "drug_name": "hydrocortisone 20 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197785", "drug_name": "hydrocortisone 25 MG/ML Topical Lotion", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "197787", "drug_name": "hydrocortisone 5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197797", "drug_name": "hydroxyurea 500 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197803", "drug_name": "ibuprofen 20 MG/ML Oral Suspension", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197805", "drug_name": "ibuprofen 400 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197806", "drug_name": "ibuprofen 600 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197807", "drug_name": "ibuprofen 800 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197815", "drug_name": "indapamide 1.25 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197816", "drug_name": "indapamide 2.5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197832", "drug_name": "isoniazid 300 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197839", "drug_name": "isosorbide dinitrate 30 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197843", "drug_name": "isotretinoin 10 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197844", "drug_name": "isotretinoin 20 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197845", "drug_name": "isotretinoin 40 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197860", "drug_name": "leucovorin 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197861", "drug_name": "leucovorin 15 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197862", "drug_name": "leucovorin 25 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197863", "drug_name": "leucovorin 5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197877", "drug_name": "lidocaine 25 MG/ML / prilocaine 25 MG/ML Topical Cream", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "197884", "drug_name": "lisinopril 40 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197885", "drug_name": "hydrochlorothiazide 12.5 MG / lisinopril 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197886", "drug_name": "hydrochlorothiazide 12.5 MG / lisinopril 20 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197887", "drug_name": "hydrochlorothiazide 25 MG / lisinopril 20 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197889", "drug_name": "lithium carbonate 300 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197890", "drug_name": "lithium carbonate 300 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197891", "drug_name": "lithium carbonate 300 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197892", "drug_name": "lithium carbonate 450 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197893", "drug_name": "lithium carbonate 600 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197894", "drug_name": "lomustine 10 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197895", "drug_name": "lomustine 100 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197896", "drug_name": "lomustine 40 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197900", "drug_name": "lorazepam 0.5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197901", "drug_name": "lorazepam 1 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197902", "drug_name": "lorazepam 2 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197903", "drug_name": "lovastatin 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "197904", "drug_name": "lovastatin 20 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "197905", "drug_name": "lovastatin 40 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "197928", "drug_name": "meprobamate 200 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197929", "drug_name": "meprobamate 400 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197931", "drug_name": "mercaptopurine 50 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197939", "drug_name": "methazolamide 25 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197940", "drug_name": "methazolamide 50 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197941", "drug_name": "methimazole 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197942", "drug_name": "methimazole 5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197943", "drug_name": "methocarbamol 500 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197944", "drug_name": "methocarbamol 750 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197949", "drug_name": "methsuximide 300 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197971", "drug_name": "methylprednisolone 32 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197973", "drug_name": "methylprednisolone 8 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197978", "drug_name": "metolazone 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197979", "drug_name": "metolazone 2.5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197984", "drug_name": "minocycline 100 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "197985", "drug_name": "minocycline 50 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198006", "drug_name": "nadolol 20 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198007", "drug_name": "nadolol 40 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198008", "drug_name": "nadolol 80 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198012", "drug_name": "naproxen 375 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198013", "drug_name": "naproxen 250 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198014", "drug_name": "naproxen 500 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198024", "drug_name": "niacin 500 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198025", "drug_name": "niacinamide 500 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198029", "drug_name": "24 HR nicotine 0.583 MG/HR Transdermal System", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198030", "drug_name": "24 HR nicotine 0.875 MG/HR Transdermal System", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198031", "drug_name": "24 HR nicotine 0.292 MG/HR Transdermal System", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198034", "drug_name": "24 HR nifedipine 30 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198035", "drug_name": "24 HR nifedipine 60 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198036", "drug_name": "24 HR nifedipine 90 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198038", "drug_name": "nitroglycerin 0.3 MG Sublingual Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198039", "drug_name": "nitroglycerin 0.4 MG Sublingual Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198040", "drug_name": "nitroglycerin 0.6 MG Sublingual Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198041", "drug_name": "nizatidine 300 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198045", "drug_name": "nortriptyline 10 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198046", "drug_name": "nortriptyline 50 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198047", "drug_name": "nortriptyline 75 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198051", "drug_name": "omeprazole 20 MG Delayed Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "198052", "drug_name": "ondansetron 4 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198057", "drug_name": "oxazepam 10 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198059", "drug_name": "oxazepam 30 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198075", "drug_name": "perphenazine 16 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198076", "drug_name": "perphenazine 2 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198077", "drug_name": "perphenazine 4 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198078", "drug_name": "perphenazine 8 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198083", "drug_name": "phenobarbital 100 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198086", "drug_name": "phenobarbital 16.2 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198089", "drug_name": "phenobarbital 60 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198102", "drug_name": "vitamin K1 5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198104", "drug_name": "pindolol 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198105", "drug_name": "pindolol 5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198116", "drug_name": "potassium chloride 20 MEQ Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198141", "drug_name": "prazosin 5 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198144", "drug_name": "prednisone 1 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198145", "drug_name": "prednisone 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198146", "drug_name": "prednisone 2.5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198148", "drug_name": "prednisone 50 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198150", "drug_name": "primidone 50 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198152", "drug_name": "probenecid 500 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198159", "drug_name": "prochlorperazine 25 MG Rectal Suppository", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198175", "drug_name": "propylthiouracil 50 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198181", "drug_name": "pyrazinamide 500 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198182", "drug_name": "pyrimethamine 25 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198188", "drug_name": "ramipril 2.5 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198189", "drug_name": "ramipril 5 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198200", "drug_name": "rifabutin 150 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198201", "drug_name": "rifampin 150 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198202", "drug_name": "rifampin 300 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198211", "drug_name": "simvastatin 40 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "198215", "drug_name": "sodium fluoride 0.55 MG Chewable Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198222", "drug_name": "spironolactone 100 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198223", "drug_name": "spironolactone 50 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198224", "drug_name": "hydrochlorothiazide 25 MG / spironolactone 25 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198228", "drug_name": "sulfadiazine 500 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198232", "drug_name": "sulfasalazine 500 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198238", "drug_name": "sulindac 150 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198239", "drug_name": "sulindac 200 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198240", "drug_name": "tamoxifen 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198241", "drug_name": "temazepam 15 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "198242", "drug_name": "temazepam 30 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "198243", "drug_name": "temazepam 7.5 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "198245", "drug_name": "terconazole 80 MG Vaginal Insert", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198250", "drug_name": "tetracycline hydrochloride 250 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "198252", "drug_name": "tetracycline hydrochloride 500 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "198270", "drug_name": "thioridazine 100 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198274", "drug_name": "thioridazine 25 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198275", "drug_name": "thioridazine 50 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198284", "drug_name": "timolol 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198285", "drug_name": "timolol 20 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198286", "drug_name": "timolol 5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198300", "drug_name": "tretinoin 1 MG/ML Topical Cream", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198316", "drug_name": "hydrochlorothiazide 25 MG / triamterene 37.5 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198322", "drug_name": "trifluoperazine 1 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198323", "drug_name": "trifluoperazine 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198324", "drug_name": "trifluoperazine 2 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198325", "drug_name": "trifluoperazine 5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198332", "drug_name": "trimethoprim 100 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198334", "drug_name": "sulfamethoxazole 400 MG / trimethoprim 80 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198335", "drug_name": "sulfamethoxazole 800 MG / trimethoprim 160 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198352", "drug_name": "zidovudine 100 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198358", "drug_name": "felbamate 400 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198359", "drug_name": "felbamate 600 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198365", "drug_name": "prochlorperazine 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198369", "drug_name": "torsemide 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198370", "drug_name": "torsemide 100 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198371", "drug_name": "torsemide 20 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198372", "drug_name": "torsemide 5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198373", "drug_name": "calcipotriene 0.00005 MG/MG Topical Ointment", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": true, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "198377", "drug_name": "tacrolimus 1 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198378", "drug_name": "tacrolimus 5 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198382", "drug_name": "famciclovir 500 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198427", "drug_name": "lamotrigine 100 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198428", "drug_name": "lamotrigine 150 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198429", "drug_name": "lamotrigine 200 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198430", "drug_name": "lamotrigine 25 MG Disintegrating Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198434", "drug_name": "acetaminophen 120 MG Rectal Suppository", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198439", "drug_name": "acetaminophen 500 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198440", "drug_name": "acetaminophen 500 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198443", "drug_name": "acetaminophen 650 MG Rectal Suppository", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198467", "drug_name": "aspirin 325 MG Delayed Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198509", "drug_name": "bisacodyl 10 MG Rectal Suppository", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198538", "drug_name": "calcium citrate 950 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198555", "drug_name": "capsaicin 0.25 MG/ML Topical Cream", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1986331", "drug_name": "valbenazine 80 MG Oral Capsule [Ingrezza]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1986354", "drug_name": "Niacinamide insulin aspart, human 100 UNT/ML Injectable Solution [Fiasp]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1986356", "drug_name": "Niacinamide 3 ML insulin aspart, human 100 UNT/ML Pen Injector [Fiasp]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198640", "drug_name": "folic acid 0.4 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1986791", "drug_name": "{21 (ethinyl estradiol 0.03 MG / norethindrone acetate 1.5 MG Oral Tablet) / 7 (ferrous fumarate 75 MG Oral Tablet) } Pack [Aurovela Fe 1.5/30 28 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198706", "drug_name": "hydrocortisone 0.01 MG/MG Topical Gel", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198707", "drug_name": "hydrocortisone 5 MG/ML Topical Cream", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198741", "drug_name": "magnesium oxide 400 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198759", "drug_name": "niacin 100 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198760", "drug_name": "niacin 50 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198806", "drug_name": "polysaccharide iron complex 150 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1988308", "drug_name": "24 HR diltiazem hydrochloride 120 MG Extended Release Oral Capsule [Tiadylt]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1988311", "drug_name": "24 HR diltiazem hydrochloride 180 MG Extended Release Oral Capsule [Tiadylt]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1988316", "drug_name": "24 HR diltiazem hydrochloride 240 MG Extended Release Oral Capsule [Tiadylt]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1988319", "drug_name": "24 HR diltiazem hydrochloride 300 MG Extended Release Oral Capsule [Tiadylt]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1988324", "drug_name": "24 HR diltiazem hydrochloride 360 MG Extended Release Oral Capsule [Tiadylt]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1988330", "drug_name": "24 HR diltiazem hydrochloride 420 MG Extended Release Oral Capsule [Tiadylt]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198852", "drug_name": "simethicone 125 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198857", "drug_name": "simethicone 66.7 MG/ML Oral Suspension", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198859", "drug_name": "sodium bicarbonate 325 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198861", "drug_name": "sodium bicarbonate 650 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198946", "drug_name": "vitamin B6 100 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1989506", "drug_name": "dolutegravir 50 MG / rilpivirine 25 MG Oral Tablet [Juluca]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1989507", "drug_name": "{24 (ethinyl estradiol 0.02 MG / norethindrone acetate 1 MG Oral Tablet) / 4 (ferrous fumarate 75 MG Oral Tablet) } Pack [Hailey 24 Fe 28 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "198952", "drug_name": "vitamin B6 250 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1989873", "drug_name": "{21 (ethinyl estradiol 0.02 MG / norethindrone acetate 1 MG Oral Tablet) / 7 (ferrous fumarate 75 MG Oral Tablet) } Pack [Hailey Fe 1/20 28 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "199047", "drug_name": "famotidine 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "199055", "drug_name": "metronidazole 375 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "199058", "drug_name": "mycophenolate mofetil 250 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "199106", "drug_name": "pyrantel pamoate 144 MG/ML Oral Suspension", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "199119", "drug_name": "omeprazole 10 MG Delayed Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "199123", "drug_name": "bicalutamide 50 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "199147", "drug_name": "lamivudine 150 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "199148", "drug_name": "lamivudine 10 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "199149", "drug_name": "acarbose 50 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "199150", "drug_name": "acarbose 100 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "199159", "drug_name": "tretinoin 10 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "199164", "drug_name": "phenobarbital 97.2 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "199167", "drug_name": "phenobarbital 32.4 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "199168", "drug_name": "phenobarbital 64.8 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "199192", "drug_name": "famciclovir 125 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "199193", "drug_name": "famciclovir 250 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1991946", "drug_name": "cetirizine hydrochloride 10 MG Oral Tablet [Aller-Tec]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "199206", "drug_name": "riluzole 50 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "199224", "drug_name": "anastrozole 1 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1992281", "drug_name": "Emollient clobetasol propionate 0.5 MG/ML Topical Cream", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1992303", "drug_name": "12 HR timolol 5 MG/ML Ophthalmic Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1992428", "drug_name": "{74 (apixaban 5 MG Oral Tablet [Eliquis]) } Pack [Eliquis 30-Day Starter Pack]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "199245", "drug_name": "glimepiride 1 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "199246", "drug_name": "glimepiride 2 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "199247", "drug_name": "glimepiride 4 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1992691", "drug_name": "ertugliflozin 2.5 MG / metformin hydrochloride 1000 MG Oral Tablet [Segluromet]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": true, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1992695", "drug_name": "ertugliflozin 2.5 MG / metformin hydrochloride 500 MG Oral Tablet [Segluromet]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": true, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1992700", "drug_name": "ertugliflozin 7.5 MG / metformin hydrochloride 1000 MG Oral Tablet [Segluromet]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": true, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1992703", "drug_name": "ertugliflozin 7.5 MG / metformin hydrochloride 500 MG Oral Tablet [Segluromet]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": true, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1992816", "drug_name": "ertugliflozin 5 MG Oral Tablet [Steglatro]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": true, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1992821", "drug_name": "ertugliflozin 15 MG Oral Tablet [Steglatro]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": true, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "199351", "drug_name": "trandolapril 2 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "199352", "drug_name": "trandolapril 4 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "199353", "drug_name": "trandolapril 1 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "199362", "drug_name": "cholecalciferol 0.025 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "199369", "drug_name": "sodium phenylbutyrate 500 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "199376", "drug_name": "potassium citrate 5 MEQ Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "199378", "drug_name": "12 HR carbamazepine 100 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "199381", "drug_name": "potassium citrate 10 MEQ Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "199387", "drug_name": "risperidone 1 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "199390", "drug_name": "etodolac 500 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "199422", "drug_name": "nevirapine 200 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "199450", "drug_name": "clobazam 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1994758", "drug_name": "{21 (ethinyl estradiol 0.035 MG / norgestimate 0.25 MG Oral Tablet) / 7 (inert ingredients 1 MG Oral Tablet) } Pack [VyLibra 28 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1994764", "drug_name": "{7 (ethinyl estradiol 0.035 MG / norgestimate 0.18 MG Oral Tablet) / 7 (ethinyl estradiol 0.035 MG / norgestimate 0.215 MG Oral Tablet) / 7 (ethinyl estradiol 0.035 MG / norgestimate 0.25 MG Oral Tablet) / 7 (inert ingredients 1 MG Oral Tablet) } Pack [Tri-VyLibra 28 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "199521", "drug_name": "vigabatrin 500 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1995479", "drug_name": "amylase 168000 UNT / lipase 40000 UNT / protease 126000 UNT Delayed Release Oral Capsule [Zenpep]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "199592", "drug_name": "tetrabenazine 25 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "199603", "drug_name": "clotrimazole 20 MG/ML Vaginal Cream", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "199663", "drug_name": "zidovudine 300 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "199672", "drug_name": "albendazole 200 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "199703", "drug_name": "cabergoline 0.5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1998482", "drug_name": "{21 (dexamethasone 1.5 MG Oral Tablet) } Pack [TaperDex 6 Day Taper]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1998772", "drug_name": "Breath-Actuated 120 ACTUAT beclomethasone dipropionate 0.08 MG/ACTUAT Metered Dose Inhaler [Qvar]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1998774", "drug_name": "Breath-Actuated 120 ACTUAT beclomethasone dipropionate 0.04 MG/ACTUAT Metered Dose Inhaler [Qvar]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "199884", "drug_name": "levofloxacin 250 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "199885", "drug_name": "levofloxacin 500 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "199888", "drug_name": "topiramate 25 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "199889", "drug_name": "topiramate 100 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "199890", "drug_name": "topiramate 200 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "199903", "drug_name": "hydrochlorothiazide 12.5 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1999314", "drug_name": "hydroxyurea 100 MG Oral Tablet [Siklos]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1999316", "drug_name": "hydroxyurea 1000 MG Oral Tablet [Siklos]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1999389", "drug_name": "{28 (ivacaftor 150 MG / tezacaftor 100 MG Oral Tablet) / 28 (ivacaftor 150 MG Oral Tablet) } Pack [Symdeko (100 MG / 150 MG; 150 MG)]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "1999673", "drug_name": "bictegravir 50 MG / emtricitabine 200 MG / tenofovir alafenamide 25 MG Oral Tablet [Biktarvy]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "1999724", "drug_name": "{21 (drospirenone 3 MG / ethinyl estradiol 0.03 MG / levomefolate calcium 0.451 MG Oral Tablet) / 7 (levomefolate calcium 0.451 MG Oral Tablet) } Pack [Tydemy 28 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2000007", "drug_name": "1 ML glatiramer acetate 40 MG/ML Prefilled Syringe [Glatopa]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "200015", "drug_name": "inositol 100 MG / niacin 400 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "200031", "drug_name": "carvedilol 6.25 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "200032", "drug_name": "carvedilol 12.5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "200033", "drug_name": "carvedilol 25 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "200034", "drug_name": "olanzapine 2.5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "200060", "drug_name": "mycophenolate mofetil 500 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "200064", "drug_name": "letrozole 2.5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "200082", "drug_name": "lamivudine 150 MG / zidovudine 300 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "200094", "drug_name": "irbesartan 75 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "200095", "drug_name": "irbesartan 150 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "200096", "drug_name": "irbesartan 300 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "200131", "drug_name": "12 HR carbamazepine 300 MG Extended Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "200132", "drug_name": "acarbose 25 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "200133", "drug_name": "12 HR carbamazepine 200 MG Extended Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2001424", "drug_name": "efavirenz 400 MG / lamivudine 300 MG / tenofovir disoproxil fumarate 300 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2001506", "drug_name": "lamotrigine 150 MG Oral Tablet [Subvenite]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2001508", "drug_name": "lamotrigine 25 MG Oral Tablet [Subvenite]", 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"prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "200251", "drug_name": "potassium phosphate 155 MG / sodium phosphate, dibasic 852 MG / sodium phosphate, monobasic 130 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "200256", "drug_name": "repaglinide 1 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "200257", "drug_name": "repaglinide 0.5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "200258", "drug_name": "repaglinide 2 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2002717", "drug_name": "nilotinib 50 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "200284", "drug_name": "hydrochlorothiazide 12.5 MG / valsartan 80 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "200285", "drug_name": "hydrochlorothiazide 12.5 MG / valsartan 160 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "200311", "drug_name": "fenofibrate 67 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2003255", "drug_name": "lamivudine 300 MG / tenofovir disoproxil fumarate 300 MG Oral Tablet [Cimduo]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "200327", "drug_name": "capecitabine 150 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "200328", "drug_name": "capecitabine 500 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "200329", "drug_name": "omeprazole 40 MG Delayed Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "2003375", "drug_name": "{24 (drospirenone 3 MG / ethinyl estradiol 0.02 MG Oral Tablet) / 4 (inert ingredients 1 MG Oral Tablet) } Pack [Lo-Zumandimine 28 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "200345", "drug_name": "simvastatin 80 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "200346", "drug_name": "cefdinir 300 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "200371", "drug_name": "citalopram 20 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2003710", "drug_name": "levonorgestrel 1.5 MG Oral Tablet [New Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "2003796", "drug_name": "lamotrigine 100 MG Oral Tablet [Subvenite]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2003797", "drug_name": "{14 (lamotrigine 100 MG Oral Tablet [Subvenite]) / 84 (lamotrigine 25 MG Oral Tablet [Subvenite]) } Pack [Subvenite Green (for Patients Taking Carbamazepine, Phenytoin, Phenobarbital, or Primidone and Not Taking Valproate)]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2003798", "drug_name": "{7 (lamotrigine 100 MG Oral Tablet [Subvenite]) / 42 (lamotrigine 25 MG Oral Tablet [Subvenite]) } Pack [Subvenite Orange (for Patients Not Taking 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[ 2026 ] } ] }, { "rxnorm_id": "2049343", "drug_name": "2.4 ML aripiprazole lauroxil 281.3 MG/ML Prefilled Syringe [Aristada]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2049380", "drug_name": "3 ML insulin isophane, human 70 UNT/ML / insulin, regular, human 30 UNT/ML Pen Injector [Novolin]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2049677", "drug_name": "cobicistat 150 MG / darunavir 800 MG / emtricitabine 200 MG / tenofovir alafenamide 10 MG Oral Tablet [Symtuza]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2050059", "drug_name": "0.5 ML hepatitis B surface antigen vaccine 0.04 MG/ML Prefilled Syringe [Heplisav-B]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "2052064", "drug_name": "{28 (norethindrone 0.35 MG Oral Tablet) } Pack [Incassia 28 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2052609", "drug_name": "tacrolimus 0.2 MG Granules for Oral Suspension [Prograf]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2052704", "drug_name": "tacrolimus 1 MG Granules for Oral Suspension [Prograf]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "205284", "drug_name": "leflunomide 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "205285", "drug_name": "leflunomide 20 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "205315", "drug_name": "topiramate 25 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, 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"HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "205326", "drug_name": "lisinopril 30 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "205328", "drug_name": "lamivudine 100 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2053512", "drug_name": "ivacaftor 125 MG / lumacaftor 100 MG Oral Granules [ORKAMBI]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2053519", "drug_name": "ivacaftor 188 MG / lumacaftor 150 MG Oral Granules [ORKAMBI]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2054157", "drug_name": "{30 (lenvatinib 4 MG Oral Capsule [Lenvima]) } Pack [Lenvima 4]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2054159", "drug_name": "{90 (lenvatinib 4 MG Oral Capsule [Lenvima]) } Pack [Lenvima 12]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2054269", "drug_name": "{7 (valbenazine 40 MG Oral Capsule 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"plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2055016", "drug_name": "stiripentol 250 MG Powder for Oral Suspension [Diacomit]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "205532", "drug_name": "dornase alfa 1 MG/ML Inhalation Solution [Pulmozyme]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2055672", "drug_name": "0.8 ML risperidone 150 MG/ML Prefilled Syringe [Perseris]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2055676", "drug_name": "0.6 ML risperidone 150 MG/ML Prefilled Syringe [Perseris]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2055766", "drug_name": "doravirine 100 MG Oral Tablet [Pifeltro]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2055815", "drug_name": "doravirine 100 MG / lamivudine 300 MG / tenofovir disoproxil fumarate 300 MG Oral Tablet [Delstrigo]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2055989", 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] }, { "rxnorm_id": "209224", "drug_name": "potassium phosphate 305 MG / sodium phosphate, monobasic 700 MG Oral Tablet [K-Phos No 2]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "209326", "drug_name": "nicotine 2 MG Chewing Gum [Nicorette]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "209353", "drug_name": "acetaminophen 120 MG Rectal Suppository [Feverall]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "209361", "drug_name": "acetaminophen 325 MG Rectal Suppository [Feverall]", 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"drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2286281", "drug_name": "osilodrostat 1 MG Oral Tablet [Isturisa]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2286290", "drug_name": "osilodrostat 5 MG Oral Tablet [Isturisa]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2288427", "drug_name": "lemborexant 10 MG Oral Tablet [Dayvigo]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2289232", 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"drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2359340", "drug_name": "pemigatinib 13.5 MG Oral Tablet [Pemazyre]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2359344", "drug_name": "pemigatinib 4.5 MG Oral Tablet [Pemazyre]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2359348", "drug_name": "pemigatinib 9 MG Oral Tablet [Pemazyre]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2360588", 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"drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "237723", "drug_name": "ergocalciferol 0.2 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "237865", "drug_name": "calcium carbonate 80 MG/ML / magnesium hydroxide 27 MG/ML Oral Suspension", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "237870", "drug_name": "aluminum hydroxide 80 MG/ML / magnesium hydroxide 80 MG/ML / simethicone 8 MG/ML Oral Suspension", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "238003", "drug_name": "168 HR estradiol 0.00208 MG/HR Transdermal System", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "238004", "drug_name": "168 HR estradiol 0.00417 MG/HR Transdermal System", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2380551", "drug_name": "12 HR fostemsavir 600 MG Extended Release Oral Tablet [Rukobia]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "238100", "drug_name": "lorazepam 2 MG/ML Injectable Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "238101", "drug_name": "lorazepam 4 MG/ML Injectable Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "238151", "drug_name": "mesalamine 66.7 MG/ML Enema", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "238600", "drug_name": "selenium sulfide 25 MG/ML Medicated Shampoo", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "238920", "drug_name": "betamethasone 0.5 MG/ML Topical Cream", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "2391560", "drug_name": "1 ML satralizumab-mwge 120 MG/ML Prefilled Syringe [Enspryng]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "239191", "drug_name": "amoxicillin 50 MG/ML Oral Suspension", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2392142", "drug_name": "0.5 ML etanercept 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2026 ] } ] }, { "rxnorm_id": "250344", "drug_name": "ciclopirox 10 MG/ML Medicated Shampoo", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "250387", "drug_name": "permethrin 10 MG/ML Medicated Shampoo", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "250820", "drug_name": "vigabatrin 500 MG Powder for Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "251020", "drug_name": "sennosides, USP 15 MG Chewable Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": 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"251292", "drug_name": "sennosides, USP 25 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "251322", "drug_name": "ethosuximide 50 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "251872", "drug_name": "pantoprazole 20 MG Delayed Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "252294", "drug_name": "simethicone 180 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "252413", "drug_name": "topiramate 50 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "252478", "drug_name": "lamotrigine 50 MG Disintegrating Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "252479", "drug_name": "lamotrigine 200 MG Disintegrating Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "252559", "drug_name": "budesonide 0.5 MG/ML Inhalation Suspension", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "2531285", "drug_name": "168 HR ethinyl estradiol 0.00146 MG/HR / norelgestromin 0.00625 MG/HR Transdermal System [Zafemy]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2532159", "drug_name": "PMDD fluoxetine 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2532163", "drug_name": "PMDD fluoxetine 20 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2539032", "drug_name": "{24 (drospirenone 3 MG / estetrol 14.2 MG Oral Tablet) / 4 (inert ingredients 1 MG Oral Tablet) } Pack [Nextstellis 28 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2539185", "drug_name": "ferrous gluconate 225 MG Oral Tablet [Fergon]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2540432", "drug_name": "{28 (cenobamate 100 MG Oral Tablet [Xcopri]) / 28 (cenobamate 150 MG Oral Tablet [Xcopri]) } Pack [Xcopri 250 MG Maintenance Pack - 100 MG (28), 150 MG (28) 56 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"plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2559702", "drug_name": "benphothiamine 150 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2562822", "drug_name": "finerenone 10 MG Oral Tablet [Kerendia]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2562826", "drug_name": "finerenone 20 MG Oral Tablet [Kerendia]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2563971", "drug_name": "3 ML insulin glargine-yfgn 100 UNT/ML Pen Injector", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2563976", "drug_name": "insulin glargine-yfgn 100 UNT/ML Injectable Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2566439", "drug_name": "{24 (ethinyl estradiol 0.02 MG / norethindrone acetate 1 MG Oral Capsule) / 4 (ferrous fumarate 75 MG Oral Capsule) } Pack [Taysofy 28 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2569571", "drug_name": "24 HR lorazepam 1 MG Extended Release Oral Capsule [Loreev]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2569575", "drug_name": "24 HR lorazepam 2 MG Extended Release Oral Capsule [Loreev]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2569580", "drug_name": "24 HR lorazepam 3 MG Extended Release Oral Capsule [Loreev]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2570398", "drug_name": "olanzapine 5 MG / samidorphan 10 MG Oral Tablet [Lybalvi]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2570401", "drug_name": "olanzapine 10 MG / samidorphan 10 MG Oral Tablet [Lybalvi]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2570404", "drug_name": "olanzapine 15 MG / samidorphan 10 MG Oral Tablet [Lybalvi]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2570407", "drug_name": "olanzapine 20 MG / samidorphan 10 MG Oral Tablet [Lybalvi]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2570419", "drug_name": "3.5 ML paliperidone palmitate 312 MG/ML Prefilled Syringe [Invega]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2570421", "drug_name": "5 ML paliperidone palmitate 312 MG/ML Prefilled Syringe [Invega]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2570757", "drug_name": "ruxolitinib 15 MG/ML Topical Cream [Opzelura]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2571842", "drug_name": "atogepant 10 MG Oral Tablet [Qulipta]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": true, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "2571846", "drug_name": "atogepant 30 MG Oral Tablet [Qulipta]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": true, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "2571850", "drug_name": "atogepant 60 MG Oral Tablet [Qulipta]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": true, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "2572292", "drug_name": "0.4 ML cyclosporine 0.5 MG/ML Ophthalmic Suspension", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "2584356", "drug_name": "bictegravir 30 MG / emtricitabine 120 MG / tenofovir alafenamide 15 MG Oral Tablet [Biktarvy]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2586427", "drug_name": "topiramate 25 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2587361", "drug_name": "0.2 ML glucagon 5 MG/ML Injection [Gvoke]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "2587899", "drug_name": "{20 (nirmatrelvir 150 MG Oral Tablet) / 10 (ritonavir 100 MG Oral Tablet) } Pack [Paxlovid 5-Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "2588062", "drug_name": "rivaroxaban 1 MG/ML Oral Suspension", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2588080", "drug_name": "3 ML cabotegravir 200 MG/ML Injection [Apretude]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2589014", "drug_name": "3 ML insulin glargine-aglr 100 UNT/ML Pen Injector [Rezvoglar]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2590643", "drug_name": "emtricitabine 120 MG / tenofovir alafenamide 15 MG Oral Tablet [Descovy]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2591786", "drug_name": "citalopram 30 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "259255", "drug_name": "atorvastatin 80 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "2594603", "drug_name": "24 HR lorazepam 1.5 MG Extended Release Oral Capsule [Loreev]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2594608", "drug_name": "siponimod 1 MG Oral Tablet [Mayzent]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2594797", "drug_name": "{7 (siponimod 0.25 MG Oral Tablet [Mayzent]) } Pack [Mayzent 1 MG Starter Pack]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "259581", "drug_name": "glycerin 2 MG/ML / hypromellose 2 MG/ML / polyethylene glycol 400 10 MG/ML Ophthalmic Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2598352", "drug_name": "abacavir 60 MG / dolutegravir 5 MG / lamivudine 30 MG Tablet for Oral Suspension [Triumeq]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2599365", "drug_name": "3 ML semaglutide 2.68 MG/ML Pen Injector [Ozempic]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": true, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "2599543", "drug_name": "{10 (nirmatrelvir 150 MG Oral Tablet) / 10 (ritonavir 100 MG Oral Tablet) } Pack [Paxlovid 150 MG /100 MG Dose Pack]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "259966", "drug_name": "methylprednisolone 4 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "260218", "drug_name": "modafinil 100 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "2602306", "drug_name": "tapinarof 10 MG/ML Topical Cream [Vtama]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "260243", "drug_name": "progesterone 100 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2603284", "drug_name": "1 ML droperidol 2.5 MG/ML Injection", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2603740", "drug_name": "molnupiravir 200 MG Oral Capsule [Lagevrio]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "260376", "drug_name": "terazosin 10 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2605950", "drug_name": "24 HR venlafaxine 112.5 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2606788", "drug_name": "zonisamide 20 MG/ML Oral Suspension [Zonisade]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2607531", "drug_name": "lumateperone 10.5 MG Oral Capsule [Caplyta]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2607535", "drug_name": "lumateperone 21 MG Oral Capsule [Caplyta]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2607737", "drug_name": "acalabrutinib 100 MG Oral Tablet [Calquence]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "260852", "drug_name": "niacin 500 MG Extended Release Oral Tablet [Slo-Niacin]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2608539", "drug_name": "roflumilast 3 MG/ML Topical Cream [Zoryve]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2608695", "drug_name": "{24 (ethinyl estradiol 0.02 MG / norethindrone acetate 1 MG Chewable Tablet) / 4 (ferrous fumarate 75 MG Oral Tablet) } Pack [Finzala 24 Fe Chewable 28 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2608698", "drug_name": "0.7 ML midazolam 14.3 MG/ML Auto-Injector", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "261021", "drug_name": "polysaccharide iron complex 150 MG Oral Capsule [Nu-Iron 150]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2611266", "drug_name": "bupropion hydrochloride 105 MG / dextromethorphan hydrobromide 45 MG Extended Release Oral Tablet [Auvelity]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "261178", "drug_name": "nystatin 100 UNT/MG Topical Powder [Nystop]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "2611951", "drug_name": "sapropterin 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"rxnorm_id": "2636046", "drug_name": "0.56 ML risperidone 357 MG/ML Prefilled Syringe [Uzedy]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2636048", "drug_name": "0.7 ML risperidone 357 MG/ML Prefilled Syringe [Uzedy]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2636050", "drug_name": "0.14 ML risperidone 357 MG/ML Prefilled Syringe [Uzedy]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2636052", "drug_name": "0.21 ML risperidone 357 MG/ML Prefilled Syringe [Uzedy]", "plans": [ { 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"rxnorm_id": "2669472", "drug_name": "amylase 252600 UNT / lipase 60000 UNT / protease 189600 UNT Delayed Release Oral Capsule [Zenpep]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2669916", "drug_name": "zuranolone 20 MG Oral Capsule [Zurzuvae]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2669920", "drug_name": "zuranolone 25 MG Oral Capsule [Zurzuvae]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2669924", "drug_name": "zuranolone 30 MG Oral Capsule [Zurzuvae]", "plans": [ { 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false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2699618", "drug_name": "trazodone hydrochloride 10 MG/ML Oral Solution [Raldesy]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2699837", "drug_name": "imatinib 80 MG/ML Oral Solution [Imkeldi]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2700386", "drug_name": "citric acid 0.01 MG/MG / lactic acid 0.018 MG/MG / potassium bitartrate 0.004 MG/MG Vaginal Gel [Phexx]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2702601", "drug_name": 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"years": [ 2026 ] } ] }, { "rxnorm_id": "2704562", "drug_name": "{21 (ethinyl estradiol 0.05 MG / ethynodiol diacetate 1 MG Oral Tablet) / 7 (inert ingredients 1 MG Oral Tablet) } Pack [Valtya 1/50 28 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2704987", "drug_name": "{6 (nirmatrelvir 150 MG Oral Tablet) / 5 (ritonavir 100 MG Oral Tablet) } Pack [Paxlovid 300 MG /100 MG ; 150 MG / 100 MG Dose Pack]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "2705814", "drug_name": "{7 (ethinyl estradiol 0.01 MG Oral Tablet) / 42 (ethinyl estradiol 0.02 MG / levonorgestrel 0.15 MG Oral Tablet) / 21 (ethinyl estradiol 0.025 MG / levonorgestrel 0.15 MG Oral 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"2709228", "drug_name": "miconazole nitrate 20 MG/ML Topical Cream [Desenex]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2709470", "drug_name": "24 HR metformin hydrochloride 1000 MG / sitagliptin phosphate 100 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2709477", "drug_name": "24 HR metformin hydrochloride 1000 MG / sitagliptin phosphate 50 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2709482", "drug_name": "24 HR metformin hydrochloride 500 MG / sitagliptin phosphate 50 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2709488", "drug_name": "metformin hydrochloride 1000 MG / sitagliptin phosphate 50 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2709491", "drug_name": "metformin hydrochloride 500 MG / sitagliptin phosphate 50 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2709603", "drug_name": "sitagliptin phosphate 100 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2709608", "drug_name": "sitagliptin phosphate 50 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2709612", "drug_name": "sitagliptin phosphate 25 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2710426", "drug_name": "cobicistat 150 MG / darunavir 675 MG Oral Tablet [Prezcobix]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2711541", "drug_name": "magnesium glycinate 100 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2711694", "drug_name": "isotretinoin 30 MG Oral Capsule [Amnesteem]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2712092", "drug_name": "{21 (ethinyl estradiol 0.03 MG / norethindrone acetate 1.5 MG Oral Tablet) } Pack [Luizza 1.5/30 21 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2712689", "drug_name": "sapropterin dihydrochloride 100 MG Powder for Oral Solution [Zelvysia]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2712691", "drug_name": "sapropterin dihydrochloride 500 MG Powder for Oral Solution [Zelvysia]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2714172", "drug_name": "cholecalciferol 0.01 MG/ML Oral Suspension", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2714180", "drug_name": "buspirone hydrochloride 7.5 MG Oral Capsule [Bucapsol]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2714182", "drug_name": "buspirone hydrochloride 10 MG Oral Capsule [Bucapsol]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2714184", "drug_name": "buspirone hydrochloride 15 MG Oral Capsule [Bucapsol]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2714235", "drug_name": "{4 (iloperidone 1 MG Oral Tablet [Fanapt]) / 2 (iloperidone 2 MG Oral Tablet [Fanapt]) / 2 (iloperidone 6 MG Oral Tablet [Fanapt]) } Pack [Fanapt Titration Pack C]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2714657", "drug_name": "{21 (ethinyl estradiol 0.02 MG / norethindrone acetate 1 MG Oral Tablet) } Pack [Luizza 1/20 21 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2716408", "drug_name": "28 ACTUAT teriparatide 0.02 MG/ACTUAT Pen Injector [Bonsity]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2716571", "drug_name": "{28 (norethindrone 0.35 MG Oral Tablet) } Pack [Meleya 28 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2716931", "drug_name": "taletrectinib 200 MG Oral Capsule [Ibtrozi]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2717197", "drug_name": "lenacapavir 300 MG Oral Tablet [Yeztugo]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2717203", "drug_name": "{2 (1.5 ML lenacapavir 309 MG/ML Injection [Yeztugo]) } Pack [Yeztugo 927 MG Kit]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2719335", "drug_name": "tolvaptan 15 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2719337", "drug_name": "tolvaptan 30 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2720071", "drug_name": "finerenone 40 MG Oral Tablet [Kerendia]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2720357", "drug_name": "{6 (iloperidone 1 MG Oral Tablet [Fanapt]) / 2 (iloperidone 2 MG Oral Tablet [Fanapt]) / 2 (iloperidone 6 MG Oral Tablet [Fanapt]) / 2 (iloperidone 8 MG Oral Tablet [Fanapt]) } Pack [Fanapt Titration Pack B]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2721192", "drug_name": "avatrombopag 10 MG Oral Granules [Doptelet]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2723452", "drug_name": "24 HR apremilast 75 MG Extended Release Oral Tablet [Otezla]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2723581", "drug_name": "liothyronine sodium 0.025 MG Oral Tablet [Liomny]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2723583", "drug_name": "liothyronine sodium 0.05 MG Oral Tablet [Liomny]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2723585", "drug_name": "liothyronine sodium 0.005 MG Oral Tablet [Liomny]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2724367", "drug_name": "{14 (24 HR apremilast 75 MG Extended Release Oral Tablet [Otezla]) / 4 (apremilast 10 MG Oral Tablet [Otezla]) / 4 (apremilast 20 MG Oral Tablet [Otezla]) / 19 (apremilast 30 MG Oral Tablet [Otezla]) } Pack [Otezla 28-Day 10/20/30/75 Starter Pack]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2724466", "drug_name": "lamotrigine 10 MG/ML Oral Suspension [Subvenite]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2725123", "drug_name": "roflumilast 0.5 MG/ML Topical Cream [Zoryve]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2725159", "drug_name": "escitalopram 15 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2729794", "drug_name": "cariprazine 0.5 MG Oral Capsule [Vraylar]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2729798", "drug_name": "cariprazine 0.75 MG Oral Capsule [Vraylar]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2730936", "drug_name": "levonorgestrel 1.5 MG Oral Tablet [Shewise]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "2732203", "drug_name": "{32 (24 HR gepirone 18.2 MG Extended Release Oral Tablet [Exxua]) } Pack [Exxua Titration Pack]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2736944", "drug_name": "semaglutide 1.5 MG Oral Tablet [Ozempic]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "2736946", "drug_name": "semaglutide 4 MG Oral Tablet [Ozempic]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "2736948", "drug_name": "semaglutide 9 MG Oral Tablet [Ozempic]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "2739001", "drug_name": "gabapentin 200 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2739007", "drug_name": "gabapentin 200 MG Oral Capsule [Relgaabi]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2741700", "drug_name": "doravirine 100 MG / islatravir 0.25 MG Oral Tablet [Idvynso]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2744290", "drug_name": "buspirone hydrochloride 2.5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2744292", "drug_name": "buspirone hydrochloride 12.5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2744515", "drug_name": "{21 (bupropion hydrochloride 105 MG / dextromethorphan hydrobromide 30 MG Extended Release Oral Tablet [Auvelity]) / 30 (bupropion hydrochloride 105 MG / dextromethorphan hydrobromide 45 MG Extended Release Oral Tablet [Auvelity]) } Pack [Auvelity Titration Pack]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2744633", "drug_name": "miconazole nitrate 20 MG/ML Topical Cream [Lasolex]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2745127", "drug_name": "everolimus 10 MG Oral Tablet [Yulithira]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2745129", "drug_name": "everolimus 2.5 MG Oral Tablet [Yulithira]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2745131", "drug_name": "everolimus 5 MG Oral Tablet [Yulithira]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2745133", "drug_name": "everolimus 7.5 MG Oral Tablet [Yulithira]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2745776", "drug_name": "milsaperidone 1 MG Oral Tablet [Bysanti]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2745780", "drug_name": "milsaperidone 10 MG Oral Tablet [Bysanti]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2745784", "drug_name": "milsaperidone 12 MG Oral Tablet [Bysanti]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2745788", "drug_name": "milsaperidone 2 MG Oral Tablet [Bysanti]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2745792", "drug_name": "milsaperidone 4 MG Oral Tablet [Bysanti]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { 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"22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2745869", "drug_name": "duloxetine 120 MG Delayed Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2746019", "drug_name": "{2 (milsaperidone 1 MG Oral Tablet [Bysanti]) / 2 (milsaperidone 2 MG Oral Tablet [Bysanti]) / 2 (milsaperidone 4 MG Oral Tablet [Bysanti]) / 2 (milsaperidone 6 MG Oral Tablet [Bysanti]) } Pack [Bysanti Titration Pack A]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2746021", "drug_name": "{6 (milsaperidone 1 MG Oral Tablet [Bysanti]) / 2 (milsaperidone 2 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"rxnorm_id": "2749695", "drug_name": "{84 (apixaban 0.5 MG Tablet for Oral Suspension [Eliquis]) } Pack [Eliquis 1.5 MG Dose Pack]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2749698", "drug_name": "{112 (apixaban 0.5 MG Tablet for Oral Suspension [Eliquis]) } Pack [Eliquis 2 MG Dose Pack]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "2749700", "drug_name": "{28 (apixaban 0.5 MG Tablet for Oral Suspension [Eliquis]) } Pack [Eliquis 0.5 MG Dose Pack]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "282401", "drug_name": "lamotrigine 25 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "282465", "drug_name": "calcium carbonate 1250 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "282485", "drug_name": "2 ML droperidol 2.5 MG/ML Injection", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "283077", "drug_name": "prednisolone 3 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "283406", "drug_name": "mirtazapine 15 MG Disintegrating Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "283407", "drug_name": "mirtazapine 30 MG Disintegrating Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "283417", "drug_name": "benzonatate 200 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "283485", "drug_name": "mirtazapine 45 MG Disintegrating Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "283523", "drug_name": "gabapentin 50 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "283535", "drug_name": "doxycycline hyclate 20 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "283536", "drug_name": "oxcarbazepine 60 MG/ML Oral Suspension", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "283639", "drug_name": "olanzapine 20 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "283641", "drug_name": "calcium carbonate 800 MG / famotidine 10 MG / magnesium hydroxide 165 MG Chewable Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "283672", "drug_name": "citalopram 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "283858", "drug_name": "ropinirole 3 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "284201", "drug_name": "zolmitriptan 2.5 MG Disintegrating Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": true, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "284202", "drug_name": "ferrous fumarate 324 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "284215", "drug_name": "clindamycin 300 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "284245", "drug_name": "famotidine 40 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "284254", "drug_name": "prochlorperazine 25 MG Rectal Suppository [Compro]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "284283", "drug_name": "bisacodyl 10 MG Rectal Suppository [The Magic Bullet]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "284380", "drug_name": "ketotifen 0.25 MG/ML Ophthalmic Solution [Zaditor]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "307668", "drug_name": "acetaminophen 32 MG/ML Oral Suspension", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "307675", "drug_name": "acetaminophen 32 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "307684", "drug_name": "acetaminophen 33.3 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "307696", "drug_name": "acetaminophen 80 MG Chewable Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "307730", "drug_name": "acyclovir 40 MG/ML Oral Suspension", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "307746", "drug_name": "aluminum hydroxide 40 MG/ML / magnesium hydroxide 40 MG/ML / simethicone 4 MG/ML Oral Suspension", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "308047", "drug_name": "alprazolam 0.25 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "308048", "drug_name": "alprazolam 0.5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "308050", "drug_name": "alprazolam 1 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "308072", "drug_name": "aluminum hydroxide 160 MG / magnesium carbonate 105 MG Chewable Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "308135", "drug_name": "amlodipine 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "308136", "drug_name": "amlodipine 2.5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "308177", "drug_name": "amoxicillin 125 MG Chewable Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "308182", "drug_name": "amoxicillin 250 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "308189", "drug_name": "amoxicillin 80 MG/ML Oral Suspension", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "308191", "drug_name": "amoxicillin 500 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "308192", "drug_name": "amoxicillin 500 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "308194", "drug_name": "amoxicillin 875 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "308212", "drug_name": "ampicillin 500 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "308377", "drug_name": "ascorbic acid 100 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "308382", "drug_name": "ascorbic acid 1000 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "308416", "drug_name": "aspirin 81 MG Delayed Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "308429", "drug_name": "atovaquone 150 MG/ML Oral Suspension", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "308459", "drug_name": "azithromycin 20 MG/ML Oral Suspension", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "308460", "drug_name": "azithromycin 250 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "308493", "drug_name": "bacitracin 0.4 UNT/MG / neomycin 0.0035 MG/MG / polymyxin B 10 UNT/MG Ophthalmic Ointment", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "308511", "drug_name": "bacitracin 0.5 UNT/MG / polymyxin B 10 UNT/MG Ophthalmic Ointment", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "308512", "drug_name": "bacitracin 0.5 UNT/MG / polymyxin 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"22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "308973", "drug_name": "carbamazepine 100 MG Chewable Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "308976", "drug_name": "carbamazepine 20 MG/ML Oral Suspension", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "308979", "drug_name": "carbamazepine 200 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": 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"22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "309049", "drug_name": "cefadroxil 500 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "309054", "drug_name": "cefdinir 25 MG/ML Oral Suspension", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "309077", "drug_name": "cefpodoxime 20 MG/ML Oral Suspension", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "309079", 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false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "309098", "drug_name": "cefuroxime 500 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "309110", "drug_name": "cephalexin 25 MG/ML Oral Suspension", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "309112", "drug_name": "cephalexin 250 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "309113", "drug_name": "cephalexin 50 MG/ML Oral Suspension", "plans": [ { 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2026 ] } ] }, { "rxnorm_id": "309289", "drug_name": "ciclopirox 7.7 MG/ML Topical Cream", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "309290", "drug_name": "ciclopirox 7.7 MG/ML Topical Lotion", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "309307", "drug_name": "ciprofloxacin 3 MG/ML Ophthalmic Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "309309", "drug_name": "ciprofloxacin 500 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "309313", "drug_name": "citalopram 2 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "309314", "drug_name": "citalopram 40 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "309318", "drug_name": "citric acid 66.8 MG/ML / potassium citrate 220 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "309322", "drug_name": "clarithromycin 50 MG/ML Oral Suspension", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "309332", "drug_name": "Once-Daily clindamycin 0.01 MG/MG Topical Gel", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "309333", "drug_name": "clindamycin 10 MG/ML Topical Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "309337", "drug_name": "clindamycin 20 MG/ML Vaginal Cream", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "309362", "drug_name": "clopidogrel 75 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "309367", "drug_name": "clotrimazole 10 MG/ML Topical Cream", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "309368", "drug_name": "clotrimazole 10 MG/ML Vaginal Cream", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "309370", "drug_name": "clotrimazole 10 MG/ML Topical Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "309371", "drug_name": "clotrimazole 10 MG Oral Lozenge", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "309374", "drug_name": "clozapine 200 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "309594", "drug_name": "vitamin B12 1 MG/ML Injectable Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "309679", "drug_name": "dexamethasone 0.001 MG/MG / neomycin 0.0035 MG/MG / polymyxin B 10 UNT/MG Ophthalmic Ointment", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "309680", "drug_name": "dexamethasone 1 MG/ML / neomycin 3.5 MG/ML / polymyxin B 10000 UNT/ML Ophthalmic Suspension", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "309686", "drug_name": "dexamethasone 0.1 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, 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"quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "310672", "drug_name": "haloperidol 5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "310687", "drug_name": "hydrocortisone 10 MG/ML / neomycin 3.5 MG/ML / polymyxin B 10000 UNT/ML Otic Suspension", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "310792", "drug_name": "hydrochlorothiazide 12.5 MG / irbesartan 150 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "310793", "drug_name": 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false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "311960", "drug_name": "niacin 500 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "311963", "drug_name": "niacin 750 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "311965", "drug_name": "niacinamide 100 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "311968", "drug_name": "niacinamide 50 MG Oral Tablet", 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] } ] }, { "rxnorm_id": "312593", "drug_name": "prazosin 1 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "312594", "drug_name": "prazosin 2 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "312614", "drug_name": "prednisolone 1 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "312615", "drug_name": "prednisone 20 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", 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"quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "312837", "drug_name": "rizatriptan 10 MG Disintegrating Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": true, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "312839", "drug_name": "rizatriptan 5 MG Disintegrating Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": true, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "312840", "drug_name": "rizatriptan 5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": true, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "312845", "drug_name": "ropinirole 0.25 MG Oral Tablet", "plans": [ { "plan_id_type": 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false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "312961", "drug_name": "simvastatin 20 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "312962", "drug_name": "simvastatin 5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "312997", "drug_name": "sodium chloride 9 MG/ML Inhalation Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "313009", "drug_name": "sodium chloride 1000 MG Oral Tablet", "plans": [ { 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"quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "313134", "drug_name": "sulfamethoxazole 40 MG/ML / trimethoprim 8 MG/ML Oral Suspension", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "313142", "drug_name": "sulfasalazine 500 MG Delayed Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "313159", "drug_name": "sumatriptan 5 MG/ACTUAT Nasal Spray", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "313160", "drug_name": "sumatriptan 100 MG Oral Tablet", 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false, "years": [ 2026 ] } ] }, { "rxnorm_id": "313447", "drug_name": "tranylcypromine 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "313450", "drug_name": "tretinoin 0.0001 MG/MG Topical Gel", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": true, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "313451", "drug_name": "tretinoin 0.00025 MG/MG Topical Gel", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": true, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "313477", "drug_name": "trifluridine 10 MG/ML Ophthalmic Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "313496", "drug_name": "trimipramine 100 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "313498", "drug_name": "trimipramine 25 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "313499", "drug_name": "trimipramine 50 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "313564", 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false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "313586", "drug_name": "venlafaxine 75 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "313776", "drug_name": "ziprasidone 40 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "313777", "drug_name": "ziprasidone 60 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "313778", "drug_name": "ziprasidone 80 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "313782", "drug_name": "acetaminophen 325 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "313797", "drug_name": "amoxicillin 25 MG/ML Oral Suspension", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "313803", "drug_name": "ascorbic acid 500 MG Chewable Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { 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"drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "314111", "drug_name": "mirtazapine 30 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "314119", "drug_name": "nicotine 2 MG Chewing Gum", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "314135", "drug_name": "naratriptan 2.5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": true, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "314142", "drug_name": "nateglinide 60 MG Oral 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"quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "314285", "drug_name": "zonisamide 100 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "314286", "drug_name": "ziprasidone 20 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "315059", "drug_name": "desoximetasone 0.0005 MG/MG Topical Gel", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "315090", "drug_name": "erythromycin 333 MG Delayed Release Oral Tablet", "plans": [ { "plan_id_type": 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false, "years": [ 2026 ] } ] }, { "rxnorm_id": "315183", "drug_name": "potassium chloride 8 MEQ Extended Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "315187", "drug_name": "prednisone 1 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "315213", "drug_name": "sodium fluoride 2.2 MG Chewable Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "315223", "drug_name": "sumatriptan 25 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", 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] }, { "rxnorm_id": "317136", "drug_name": "nortriptyline 25 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "317160", "drug_name": "temozolomide 100 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "317173", "drug_name": "captopril 25 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "317174", "drug_name": "quetiapine 200 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "317573", "drug_name": "pioglitazone 15 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "317769", "drug_name": "theophylline 300 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "317865", "drug_name": "calcium carbonate 400 MG Chewable Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "318202", "drug_name": 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"step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "328176", "drug_name": "primidone 125 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "343033", "drug_name": "dexamethasone 0.75 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "346574", "drug_name": "theophylline 200 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "348472", "drug_name": "theophylline 600 MG Extended Release Oral Tablet", 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"GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "349194", "drug_name": "clonazepam 0.125 MG Disintegrating Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "349195", "drug_name": "clonazepam 0.25 MG Disintegrating Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "349196", "drug_name": "clonazepam 1 MG Disintegrating Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "349197", 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"prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "349201", "drug_name": "valsartan 160 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "349208", "drug_name": "sirolimus 1 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "349251", "drug_name": "tenofovir disoproxil fumarate 300 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "349253", "drug_name": "bosentan 62.5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "349287", "drug_name": "fenofibrate 160 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "349332", "drug_name": "escitalopram 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "349351", "drug_name": "desonide 0.5 MG/ML Topical Cream", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "349353", "drug_name": "hydrochlorothiazide 25 MG / valsartan 160 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "349434", "drug_name": "voriconazole 200 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "349435", "drug_name": "voriconazole 50 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "349477", "drug_name": "efavirenz 600 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "349483", "drug_name": "valsartan 40 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "349490", "drug_name": "aripiprazole 15 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "349491", "drug_name": "lamivudine 300 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "349514", "drug_name": "celecoxib 400 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "349545", "drug_name": "aripiprazole 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "349547", "drug_name": "aripiprazole 30 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "349553", "drug_name": "aripiprazole 20 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "349556", "drug_name": "ezetimibe 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "349591", "drug_name": "atomoxetine 10 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "349592", "drug_name": "atomoxetine 18 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "349593", "drug_name": "atomoxetine 25 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "349594", "drug_name": "atomoxetine 40 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "349595", "drug_name": "atomoxetine 60 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "351107", "drug_name": "olanzapine 15 MG Disintegrating Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "351108", "drug_name": "olanzapine 20 MG Disintegrating Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "351109", "drug_name": "budesonide 0.25 MG/ML Inhalation Suspension", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "351133", "drug_name": "fenofibrate 54 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "351134", "drug_name": "zolmitriptan 5 MG Disintegrating Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": true, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "351136", "drug_name": "albuterol 0.417 MG/ML Inhalation Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "351137", "drug_name": "albuterol 0.21 MG/ML Inhalation Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "351223", "drug_name": "ziprasidone 20 MG Injection", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "351246", "drug_name": "montelukast 4 MG Oral Granules", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "351249", "drug_name": "escitalopram 5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "351250", "drug_name": "escitalopram 20 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "351256", "drug_name": "eplerenone 25 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "351257", "drug_name": "eplerenone 50 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "351264", "drug_name": "buprenorphine 2 MG Sublingual Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "351265", "drug_name": "buprenorphine 8 MG Sublingual Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "351266", "drug_name": "buprenorphine 2 MG / naloxone 0.5 MG Sublingual Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "351267", "drug_name": "buprenorphine 8 MG / naloxone 2 MG Sublingual Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "351285", "drug_name": "escitalopram 1 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "351427", "drug_name": "24 HR nicotine 0.583 MG/HR Transdermal System [Nicoderm C-Q]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "351429", "drug_name": "24 HR nicotine 0.875 MG/HR Transdermal System [Nicoderm C-Q]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "351433", "drug_name": "24 HR nicotine 0.292 MG/HR Transdermal System [Nicoderm C-Q]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "351926", "drug_name": "insulin aspart, human 100 UNT/ML Injectable Solution [NovoLog]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "353538", "drug_name": "24 HR isosorbide mononitrate 60 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "359228", "drug_name": "azathioprine 100 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "359229", "drug_name": "azathioprine 75 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "359296", "drug_name": "calcium acetate 667 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "359385", "drug_name": "24 HR clarithromycin 500 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "359500", "drug_name": "24 HR etodolac 500 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "359601", "drug_name": "guaifenesin 400 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { 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"GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "381056", "drug_name": "isosorbide dinitrate 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "386989", "drug_name": "calcium carbonate 1250 MG / cholecalciferol 0.01 MG Chewable Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "387003", "drug_name": "levetiracetam 1000 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": 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"22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "392038", "drug_name": "sodium fluoride 0.011 MG/MG Toothpaste", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "393245", "drug_name": "digoxin 0.05 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "401953", "drug_name": "risperidone 1 MG Disintegrating Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": 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"prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "402014", "drug_name": "omeprazole 20 MG Delayed Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "402109", "drug_name": "fosamprenavir 700 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "402131", "drug_name": "aripiprazole 5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "402246", "drug_name": "atazanavir 150 MG Oral 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false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "402695", "drug_name": "24 HR felodipine 10 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "402696", "drug_name": "24 HR felodipine 5 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "402698", "drug_name": "24 HR felodipine 2.5 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "403810", "drug_name": 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false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "403850", "drug_name": "carbidopa 12.5 MG / entacapone 200 MG / levodopa 50 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "403851", "drug_name": "carbidopa 25 MG / entacapone 200 MG / levodopa 100 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "403852", "drug_name": "carbidopa 37.5 MG / entacapone 200 MG / levodopa 150 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "403875", "drug_name": "emtricitabine 200 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "403878", "drug_name": "imatinib 100 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "403879", "drug_name": "imatinib 400 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "403884", "drug_name": "levetiracetam 100 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "403908", "drug_name": "ciprofloxacin 3 MG/ML / dexamethasone 1 MG/ML Otic Suspension", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "403922", "drug_name": "168 HR estradiol 0.00156 MG/HR Transdermal System", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "403923", "drug_name": "168 HR estradiol 0.0025 MG/HR Transdermal System", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "403930", "drug_name": "isotretinoin 30 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "403966", "drug_name": "zonisamide 25 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "403967", "drug_name": "zonisamide 50 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "403969", "drug_name": "fluoxetine 25 MG / olanzapine 6 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "403970", "drug_name": "fluoxetine 25 MG / olanzapine 12 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "403971", "drug_name": "fluoxetine 50 MG / olanzapine 12 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "403972", "drug_name": "fluoxetine 50 MG / olanzapine 6 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "404058", "drug_name": "isotretinoin 10 MG Oral Capsule [Amnesteem]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "404059", "drug_name": "isotretinoin 10 MG Oral Capsule [Claravis]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "404061", "drug_name": "isotretinoin 20 MG Oral Capsule [Amnesteem]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "404062", "drug_name": "isotretinoin 20 MG Oral Capsule [Claravis]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "404064", "drug_name": "isotretinoin 40 MG Oral Capsule [Amnesteem]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "404065", "drug_name": "isotretinoin 40 MG Oral Capsule [Claravis]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "404125", "drug_name": "benzoyl peroxide 100 MG/ML Topical Cream [Clearskin]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "404127", "drug_name": "benzoyl peroxide 0.1 MG/MG Topical Gel [Acne-Clear]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "404179", "drug_name": "calcium carbonate 420 MG Chewable Tablet [Titralac]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "404280", "drug_name": "polysaccharide iron complex 150 MG Oral Capsule [Ferrex-150]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "404318", "drug_name": "sennosides, USP 15 MG Oral Tablet [Perdiem Overnight]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "404369", "drug_name": "ferrous fumarate 324 MG Oral Tablet [Ferrocite]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "404449", "drug_name": "thalidomide 100 MG Oral Capsule [Thalomid]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "404472", "drug_name": "aluminum hydroxide 50.8 MG/ML / magnesium carbonate 47.5 MG/ML Oral Suspension [Gaviscon]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "404475", "drug_name": "azathioprine 75 MG Oral Tablet [Azasan]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "404476", "drug_name": "azathioprine 100 MG Oral Tablet [Azasan]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "406503", "drug_name": "doxercalciferol 0.0005 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "410584", "drug_name": "sertraline 150 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "412113", "drug_name": "vitamin E 180 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "428485", "drug_name": "calcium carbonate 1500 MG / cholecalciferol 0.01 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "429212", "drug_name": "clozapine 50 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "429503", "drug_name": "hydrochlorothiazide 12.5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "430902", "drug_name": "baclofen 5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "432400", "drug_name": "cinacalcet 90 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "432401", "drug_name": "cinacalcet 60 MG Oral Tablet", "plans": [ { "plan_id_type": 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"quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "476556", "drug_name": "emtricitabine 200 MG / tenofovir disoproxil fumarate 300 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "476576", "drug_name": "cefdinir 50 MG/ML Oral Suspension", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "476809", "drug_name": "mirtazapine 7.5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "477391", "drug_name": "levofloxacin 25 MG/ML Oral Solution", "plans": [ 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false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "483325", "drug_name": "levonorgestrel 1.5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "483438", "drug_name": "pregabalin 100 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": true, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "483440", "drug_name": "pregabalin 150 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": true, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "483442", "drug_name": "pregabalin 25 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": true, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "483444", "drug_name": "pregabalin 300 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": true, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "483446", "drug_name": "pregabalin 200 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": true, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "483448", "drug_name": "pregabalin 50 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": true, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "483450", "drug_name": 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"GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "485414", "drug_name": "alprazolam 1 MG Disintegrating Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "485415", "drug_name": "alprazolam 0.5 MG Disintegrating Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "485416", "drug_name": "alprazolam 2 MG Disintegrating Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "485434", 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"step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "485968", "drug_name": "olanzapine 10 MG Injection", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "486131", "drug_name": "benzoyl peroxide 0.1 MG/MG Topical Gel", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "486146", "drug_name": "24 HR nitroglycerin 0.6 MG/HR Transdermal System", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "486148", "drug_name": "24 HR nitroglycerin 0.2 MG/HR Transdermal 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"prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "562266", "drug_name": "clindamycin 15 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "562508", "drug_name": "amoxicillin 875 MG / clavulanate 125 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "562510", "drug_name": "sodium fluoride 2 MG/ML Mouthwash", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "562524", "drug_name": "12 HR acetazolamide 500 MG Extended Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "562704", "drug_name": "ropinirole 4 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "577033", "drug_name": "sildenafil 20 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "577040", "drug_name": "calcium carbonate 648 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "577057", "drug_name": "72 HR fentanyl 0.012 MG/HR Transdermal System", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": true, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "577127", "drug_name": "pregabalin 225 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": true, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "577237", "drug_name": "metronidazole 0.01 MG/MG Topical Gel", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": true, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "577315", "drug_name": "paricalcitol 0.001 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "577317", "drug_name": "paricalcitol 0.002 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "577324", "drug_name": "paricalcitol 0.004 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "577348", "drug_name": "ramelteon 8 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "577395", "drug_name": "capsaicin 0.35 MG/ML Topical Cream", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "577927", "drug_name": "mineral oil 45 MG/ML / mineral oil, light 10 MG/ML Ophthalmic Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "577957", "drug_name": "amphetamine aspartate 3.75 MG / amphetamine sulfate 3.75 MG / dextroamphetamine saccharate 3.75 MG / dextroamphetamine sulfate 3.75 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "577961", "drug_name": "amphetamine aspartate 5 MG / amphetamine sulfate 5 MG / dextroamphetamine saccharate 5 MG / dextroamphetamine sulfate 5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "579148", "drug_name": "galantamine 12 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "579907", "drug_name": "carboxymethylcellulose sodium 0.01 MG/MG Ophthalmic Gel", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "579999", "drug_name": "mineral oil 0.319 MG/MG / petrolatum 0.577 MG/MG Ophthalmic Ointment", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "580001", "drug_name": "mineral oil 0.415 MG/MG / petrolatum 0.568 MG/MG Ophthalmic Ointment", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "582299", "drug_name": "6-aminocaproic acid 250 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "582926", "drug_name": "podofilox 5 MG/ML Topical Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "596843", "drug_name": "lansoprazole 15 MG Delayed Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "596918", "drug_name": "lansoprazole 15 MG Delayed Release Oral Capsule [Prevacid]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "596926", "drug_name": "duloxetine 20 MG Delayed Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "596930", "drug_name": "duloxetine 30 MG Delayed Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "596934", "drug_name": "duloxetine 60 MG Delayed Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "597730", "drug_name": "lopinavir 200 MG / ritonavir 50 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "597768", "drug_name": "deferasirox 125 MG Tablet for Oral Suspension", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "597770", "drug_name": "deferasirox 250 MG Tablet for Oral Suspension", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "597772", "drug_name": "deferasirox 500 MG Tablet for Oral Suspension", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "597850", "drug_name": "anagrelide 0.5 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "597852", "drug_name": "anagrelide 1 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "598006", "drug_name": "erythromycin 250 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "598025", "drug_name": "amoxicillin 250 MG Chewable Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "598050", "drug_name": "polyvinyl alcohol 0.005 ML/ML / povidone 6 MG/ML Ophthalmic Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "602393", "drug_name": "abacavir 600 MG / lamivudine 300 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "602399", "drug_name": "gabapentin 100 MG Oral Tablet [Gabarone]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "602407", "drug_name": "gabapentin 400 MG Oral Tablet [Gabarone]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "602910", "drug_name": "lenalidomide 10 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "602912", "drug_name": "lenalidomide 5 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "602964", "drug_name": "aripiprazole 2 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "603103", "drug_name": "naproxen 375 MG Delayed Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "603203", "drug_name": "erlotinib 100 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "603206", "drug_name": "erlotinib 150 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "603208", "drug_name": "erlotinib 25 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "603378", "drug_name": "tipranavir 250 MG Oral Capsule [Aptivus]", 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"quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "608143", "drug_name": "atomoxetine 80 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "608796", "drug_name": "omeprazole 20 MG Delayed Release Oral Tablet [Prilosec]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "616148", "drug_name": "emtricitabine 10 MG/ML Oral Solution [Emtriva]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "616279", "drug_name": "sunitinib 12.5 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "616285", "drug_name": "sunitinib 25 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "616289", "drug_name": "sunitinib 50 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "616402", "drug_name": "duloxetine 40 MG Delayed Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "616483", "drug_name": "quetiapine 400 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "616487", "drug_name": "quetiapine 50 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "616539", "drug_name": "omeprazole 20 MG / sodium bicarbonate 1100 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "616578", "drug_name": "lubiprostone 0.024 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "616698", "drug_name": "risperidone 3 MG Disintegrating Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "616705", "drug_name": "risperidone 4 MG Disintegrating Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "617296", "drug_name": "amoxicillin 500 MG / clavulanate 125 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "617310", "drug_name": "atorvastatin 20 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "617311", "drug_name": "atorvastatin 40 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "617312", "drug_name": "atorvastatin 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "617322", "drug_name": "amoxicillin 50 MG/ML / clavulanate 12.5 MG/ML Oral Suspension", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "617423", "drug_name": "amoxicillin 40 MG/ML / clavulanate 5.7 MG/ML Oral Suspension", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "617430", "drug_name": "amoxicillin 80 MG/ML / clavulanate 11.4 MG/ML Oral Suspension", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "617954", "drug_name": "calamine 80 MG/ML / zinc oxide 80 MG/ML Topical Lotion", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "617993", "drug_name": "amoxicillin 120 MG/ML / clavulanate 8.58 MG/ML Oral Suspension", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "628953", "drug_name": "potassium chloride 10 MEQ Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "628958", "drug_name": "potassium chloride 10 MEQ Extended Release Oral Tablet [Klor-Con]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "630196", "drug_name": "sodium fluoride 0.011 MG/MG Toothpaste [Denta 5000 Plus]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "630208", "drug_name": "albuterol 0.83 MG/ML Inhalation Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "635970", "drug_name": "ferrous sulfate 325 MG Oral Tablet [Feosol]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "636042", "drug_name": "hydrochlorothiazide 12.5 MG / valsartan 320 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "636045", "drug_name": "hydrochlorothiazide 25 MG / valsartan 320 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "636522", "drug_name": "12 HR guaifenesin 600 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "636671", "drug_name": "varenicline 0.5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "636676", "drug_name": "varenicline 1 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "637173", "drug_name": "cephalexin 750 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "639566", "drug_name": "vitamin B6 50 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "642346", "drug_name": "bismuth subsalicylate 17.5 MG/ML Oral Suspension [Kaopectate Reformulated Aug 2006]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", 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2026 ] } ] }, { "rxnorm_id": "672910", "drug_name": "12 HR carbamazepine 200 MG Extended Release Oral Capsule [Equetro]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "685054", "drug_name": "cholecalciferol 0.25 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "686379", "drug_name": "celecoxib 50 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "686400", "drug_name": "erythromycin ethylsuccinate 40 MG/ML Oral Suspension", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "686924", "drug_name": "carvedilol 3.125 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "687043", "drug_name": "amphetamine aspartate 3.125 MG / amphetamine sulfate 3.125 MG / dextroamphetamine saccharate 3.125 MG / dextroamphetamine sulfate 3.125 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "688242", "drug_name": "estrogens, conjugated (USP) 0.625 MG/ML Vaginal Cream [Premarin]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "692783", "drug_name": "loratadine 1 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "700883", "drug_name": "temozolomide 140 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "700885", "drug_name": "temozolomide 180 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "701392", 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"quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "705728", "drug_name": "cholecalciferol 1.25 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "705934", "drug_name": "tolnaftate 0.01 MG/MG Powder Spray", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "706820", "drug_name": "mineral oil 0.03 MG/MG / petrolatum 0.94 MG/MG Ophthalmic Ointment", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "706822", "drug_name": "risperidone 12.5 MG Injection", "plans": [ { 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false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "793741", "drug_name": "sodium polystyrene sulfonate 250 MG/ML Oral Suspension [Kionex]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "794229", "drug_name": "aspirin 81 MG Delayed Release Oral Tablet [Bayer Aspirin]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "794244", "drug_name": "capsaicin 1 MG/ML Topical Cream [Capzasin-HP]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "794639", 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false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "801957", "drug_name": "0.5 ML diazepam 5 MG/ML Rectal Gel", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "801961", "drug_name": "2 ML diazepam 5 MG/ML Rectal Gel", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "801966", "drug_name": "4 ML diazepam 5 MG/ML Rectal Gel", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "802652", "drug_name": "1 ML etanercept 50 MG/ML Prefilled Syringe [Enbrel]", 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"prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "808753", "drug_name": "24 HR venlafaxine 75 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "809159", "drug_name": "0.5 ML etanercept 50 MG/ML Prefilled Syringe [Enbrel]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "809316", "drug_name": "benzoyl peroxide 40 MG/ML Medicated Liquid Soap", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": 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{ "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "809974", "drug_name": "20 ML lacosamide 10 MG/ML Injection", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "809987", "drug_name": "lacosamide 100 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "809992", "drug_name": "lacosamide 150 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "809996", "drug_name": "lacosamide 200 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "810000", "drug_name": "lacosamide 50 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "810083", "drug_name": "carbidopa 31.25 MG / entacapone 200 MG / levodopa 125 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "810090", "drug_name": "carbidopa 18.75 MG / entacapone 200 MG / levodopa 75 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "824295", "drug_name": "rufinamide 200 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "824301", "drug_name": "rufinamide 400 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "825130", "drug_name": "24 HR mesalamine 375 MG Extended Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "825180", "drug_name": "aspirin 81 MG Chewable Tablet [Bayer Aspirin]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "826860", "drug_name": "ascorbic acid 60 MG / biotin 0.3 MG / folic acid 0.8 MG / mecobalamin 0.006 MG / niacinamide 20 MG / pantothenate 10 MG / pyridoxine 10 MG / riboflavin 1.7 MG / thiamine 1.5 MG Oral Tablet [Dialyvite 800]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "828269", "drug_name": "loratadine 10 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "828320", "drug_name": "cyclobenzaprine hydrochloride 5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "828348", "drug_name": "cyclobenzaprine hydrochloride 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "829993", "drug_name": "cholecalciferol 0.833 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "830245", "drug_name": "1 ML hepatitis B surface antigen vaccine 0.01 MG/ML Prefilled Syringe [Recombivax]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "830253", "drug_name": "0.5 ML hepatitis B surface antigen vaccine 0.01 MG/ML Prefilled Syringe [Recombivax]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "830263", "drug_name": "1 ML hepatitis B surface antigen vaccine 0.04 MG/ML Injection [Recombivax]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "830795", "drug_name": "24 HR diltiazem hydrochloride 360 MG Extended Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "830801", "drug_name": "24 HR diltiazem hydrochloride 300 MG Extended Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "830837", "drug_name": "24 HR diltiazem hydrochloride 240 MG Extended Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "830845", "drug_name": "24 HR diltiazem hydrochloride 180 MG Extended Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "830861", "drug_name": "24 HR diltiazem hydrochloride 120 MG Extended Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "830865", "drug_name": "12 HR diltiazem hydrochloride 60 MG Extended Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "830869", "drug_name": "12 HR diltiazem hydrochloride 90 MG Extended Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "830872", "drug_name": "12 HR diltiazem hydrochloride 120 MG Extended Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "830877", "drug_name": "24 HR diltiazem hydrochloride 180 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "830879", "drug_name": "24 HR diltiazem hydrochloride 240 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "830882", "drug_name": "24 HR diltiazem hydrochloride 300 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "830897", "drug_name": "24 HR diltiazem hydrochloride 360 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "830900", "drug_name": "24 HR diltiazem hydrochloride 420 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "831054", "drug_name": "diltiazem hydrochloride 120 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "831102", "drug_name": "diltiazem hydrochloride 90 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "831103", "drug_name": "diltiazem hydrochloride 60 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "831109", "drug_name": "cromolyn sodium 40 MG/ML Ophthalmic Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "831215", "drug_name": "24 HR diltiazem hydrochloride 120 MG Extended Release Oral Capsule [Dilt]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "831226", "drug_name": "24 HR diltiazem hydrochloride 120 MG Extended Release Oral Capsule [Cartia]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "831246", "drug_name": "cromolyn sodium 10 MG/ML Inhalation Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "831252", "drug_name": "24 HR 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"plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "831870", "drug_name": "darunavir 75 MG Oral Tablet [Prezista]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "831872", "drug_name": "{21 (desogestrel 0.15 MG / ethinyl estradiol 0.02 MG Oral Tablet) / 5 (ethinyl estradiol 0.01 MG Oral Tablet) / 2 (inert ingredients 1 MG Oral Tablet) } Pack [Azurette 28 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "832718", "drug_name": "potassium chloride 8 MEQ Extended Release Oral Tablet [Klor-Con]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "833008", "drug_name": "desmopressin acetate 0.2 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "833217", "drug_name": "diltiazem hydrochloride 30 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "833528", "drug_name": "amiodarone hydrochloride 200 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "833709", "drug_name": "24 HR tramadol hydrochloride 100 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": true, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "833711", "drug_name": "24 HR tramadol hydrochloride 200 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": true, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "833713", "drug_name": "24 HR tramadol hydrochloride 300 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": true, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "834022", "drug_name": "ketorolac 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"prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "834102", "drug_name": "penicillin V potassium 500 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "834127", "drug_name": "chlorhexidine gluconate 1.2 MG/ML Mouthwash", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "834137", "drug_name": "chlorhexidine gluconate 1.2 MG/ML Mouthwash [Periogard]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "834348", "drug_name": "amiodarone hydrochloride 400 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "835564", "drug_name": "imipramine hydrochloride 25 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "835568", "drug_name": "imipramine hydrochloride 50 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "835572", "drug_name": "imipramine pamoate 75 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "835577", "drug_name": "imipramine pamoate 150 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "835589", "drug_name": "imipramine pamoate 125 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "835591", "drug_name": "imipramine pamoate 100 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "835593", "drug_name": "imipramine hydrochloride 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "835603", "drug_name": "tramadol hydrochloride 50 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "835726", "drug_name": "acamprosate calcium 333 MG Delayed Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "835835", "drug_name": "cyclosporine, modified 100 MG Oral Capsule [Gengraf]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "835886", "drug_name": "cyclosporine, modified 100 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "835894", "drug_name": "cyclosporine, modified 25 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "835896", "drug_name": "cyclosporine, modified 25 MG Oral Capsule [Gengraf]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "835913", "drug_name": "mefloquine hydrochloride 250 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "835925", "drug_name": "cyclosporine, modified 50 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "835956", "drug_name": "amiodarone hydrochloride 100 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "836358", "drug_name": "ipratropium bromide 0.2 MG/ML Inhalation Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "836395", "drug_name": "acetaminophen 325 MG / tramadol hydrochloride 37.5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "836634", "drug_name": "1 ML hepatitis A virus strain CR 326F antigen, inactivated 50 UNT/ML Prefilled Syringe [Vaqta]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "836636", "drug_name": "0.5 ML hepatitis A virus strain CR 326F antigen, inactivated 50 UNT/ML Prefilled Syringe [Vaqta]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "844590", "drug_name": "theophylline 100 MG Extended Release Oral Capsule [Theo-24]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "844591", "drug_name": "theophylline 300 MG Extended Release Oral Capsule [Theo-24]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "844813", "drug_name": "theophylline 200 MG Extended Release Oral Capsule [Theo-24]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "844829", "drug_name": "theophylline 400 MG Extended Release Oral Capsule [Theo-24]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "845488", "drug_name": "ramipril 1.25 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "845507", "drug_name": "everolimus 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "845515", "drug_name": "everolimus 5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "845836", "drug_name": "benzoyl peroxide 25 MG/ML Medicated Liquid Soap", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "846161", "drug_name": "hydrocortisone 0.01 MG/MG Topical Gel [Cortizone]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "846192", "drug_name": "{21 (dexamethasone 1.5 MG Oral Tablet) } Pack", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "846378", "drug_name": "24 HR levetiracetam 750 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "847121", "drug_name": "calcium citrate 1500 MG / cholecalciferol 250 UNT Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "847189", "drug_name": "3 ML insulin isophane, human 70 UNT/ML / insulin, regular, human 30 UNT/ML Pen Injector [Humulin]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "847199", "drug_name": "3 ML 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[ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "847254", "drug_name": "3 ML insulin lispro 25 UNT/ML / insulin lispro protamine, human 75 UNT/ML Pen Injector [Humalog Mix]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "847261", "drug_name": "3 ML insulin glulisine, human 100 UNT/ML Pen Injector [Apidra]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "847348", "drug_name": "1.5 ML somatropin 6.67 MG/ML Pen Injector [Norditropin]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": 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"quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "854880", "drug_name": "zolpidem tartrate 12.5 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "854894", "drug_name": "zolpidem tartrate 6.25 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "854901", "drug_name": "bisoprolol fumarate 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "854905", "drug_name": "bisoprolol fumarate 5 MG Oral Tablet", 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"22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "855178", "drug_name": "tolterodine tartrate 1 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "855194", "drug_name": "tolterodine tartrate 2 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "855205", "drug_name": "docosanol 100 MG/ML Topical Cream [Abreva]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "855288", "drug_name": "warfarin sodium 1 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "855296", "drug_name": "warfarin sodium 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "855302", "drug_name": "warfarin sodium 2 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "855312", "drug_name": "warfarin sodium 2.5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "855318", "drug_name": "warfarin sodium 3 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "855324", "drug_name": "warfarin sodium 4 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "855332", "drug_name": "warfarin sodium 5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "855338", "drug_name": "warfarin sodium 6 MG Oral 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false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "855633", "drug_name": "diclofenac sodium 0.01 MG/MG Topical Gel", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "855635", "drug_name": "diclofenac sodium 0.01 MG/MG Topical Gel [Voltaren]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "855657", "drug_name": "24 HR diclofenac sodium 100 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "855664", "drug_name": "diclofenac sodium 25 MG Delayed Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "855671", "drug_name": "phenytoin sodium 100 MG Extended Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "855812", "drug_name": "prasugrel 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "855818", "drug_name": "prasugrel 5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "855861", "drug_name": "phenytoin sodium 200 MG Extended Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "855863", "drug_name": "phenytoin sodium 200 MG Extended Release Oral Capsule [Phenytek]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "855871", "drug_name": "phenytoin sodium 30 MG Extended Release Oral Capsule [Dilantin]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "855873", "drug_name": "phenytoin sodium 300 MG Extended Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "855875", "drug_name": "phenytoin sodium 300 MG Extended Release Oral Capsule [Phenytek]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "855906", "drug_name": "diclofenac sodium 50 MG Delayed Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "855926", "drug_name": "diclofenac sodium 75 MG Delayed Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "855942", "drug_name": "diclofenac potassium 50 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "856364", "drug_name": "trazodone hydrochloride 150 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "856369", "drug_name": "trazodone hydrochloride 300 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "856373", "drug_name": "trazodone hydrochloride 100 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "856377", "drug_name": "trazodone hydrochloride 50 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "856448", "drug_name": "propranolol hydrochloride 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "856457", "drug_name": "propranolol hydrochloride 20 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "856460", "drug_name": "24 HR propranolol hydrochloride 120 MG Extended Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "856467", "drug_name": "{7 (ethinyl estradiol 0.025 MG / norgestimate 0.18 MG Oral Tablet) / 7 (ethinyl estradiol 0.025 MG / norgestimate 0.215 MG Oral Tablet) / 7 (ethinyl estradiol 0.025 MG / norgestimate 0.25 MG Oral Tablet) / 7 (inert ingredients 1 MG Oral Tablet) } Pack [Tri-Lo-Sprintec 28 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "856481", "drug_name": "24 HR propranolol hydrochloride 160 MG Extended Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "856519", "drug_name": "propranolol hydrochloride 40 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "856535", "drug_name": "24 HR propranolol hydrochloride 60 MG Extended Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "856556", "drug_name": "propranolol hydrochloride 60 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "856569", "drug_name": "24 HR propranolol hydrochloride 80 MG Extended Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "856578", "drug_name": "propranolol hydrochloride 80 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "856652", "drug_name": "dantrolene sodium 100 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "856656", "drug_name": "dantrolene sodium 25 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "856660", "drug_name": "dantrolene sodium 50 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "856666", "drug_name": "rifaximin 550 MG Oral Tablet [XIFAXAN]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "856706", "drug_name": "amitriptyline hydrochloride 10 MG / perphenazine 2 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "856720", "drug_name": "amitriptyline hydrochloride 10 MG / perphenazine 4 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "856724", "drug_name": "propranolol hydrochloride 4 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "856733", "drug_name": "propranolol hydrochloride 8 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "856762", "drug_name": "amitriptyline hydrochloride 100 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "856769", "drug_name": "amitriptyline hydrochloride 12.5 MG / chlordiazepoxide 5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "856773", "drug_name": "amitriptyline hydrochloride 150 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "856783", "drug_name": "amitriptyline hydrochloride 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "856792", "drug_name": "amitriptyline hydrochloride 25 MG / chlordiazepoxide 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "856797", "drug_name": "amitriptyline hydrochloride 25 MG / perphenazine 2 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "856825", "drug_name": "amitriptyline hydrochloride 25 MG / perphenazine 4 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "856834", "drug_name": "amitriptyline hydrochloride 25 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "856840", "drug_name": "amitriptyline hydrochloride 50 MG / perphenazine 4 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "856845", "drug_name": "amitriptyline hydrochloride 50 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "856853", "drug_name": "amitriptyline hydrochloride 75 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "856940", "drug_name": "acetaminophen 21.7 MG/ML / hydrocodone bitartrate 0.5 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "856999", "drug_name": "acetaminophen 325 MG / hydrocodone bitartrate 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "857002", "drug_name": "acetaminophen 325 MG / hydrocodone bitartrate 5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "857005", "drug_name": "acetaminophen 325 MG / hydrocodone bitartrate 7.5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "857166", "drug_name": "fosinopril sodium 10 MG / hydrochlorothiazide 12.5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "857169", "drug_name": "fosinopril sodium 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "857174", "drug_name": "fosinopril sodium 20 MG / hydrochlorothiazide 12.5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "857183", "drug_name": "fosinopril sodium 20 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "857187", "drug_name": "fosinopril sodium 40 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "857297", "drug_name": "clomipramine hydrochloride 25 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "857301", "drug_name": "clomipramine hydrochloride 50 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "857305", "drug_name": "clomipramine hydrochloride 75 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "857321", "drug_name": "bethanechol chloride 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "857328", "drug_name": "bethanechol chloride 25 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "857336", "drug_name": "bethanechol chloride 5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "857340", "drug_name": "bethanechol chloride 50 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "857430", "drug_name": "clemastine fumarate 0.134 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "857466", "drug_name": "cholecalciferol 0.125 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "857560", "drug_name": "trospium chloride 20 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "857564", "drug_name": "24 HR trospium chloride 60 MG Extended Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "857677", "drug_name": "terbutaline sulfate 2.5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "857683", "drug_name": "terbutaline sulfate 5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "857799", "drug_name": "treprostinil 0.6 MG/ML Inhalation Solution [Tyvaso]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "858051", "drug_name": "0.5 ML paliperidone palmitate 156 MG/ML Prefilled Syringe [Invega]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "858053", "drug_name": "1.5 ML paliperidone palmitate 156 MG/ML Prefilled Syringe [Invega]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "858055", "drug_name": "1 ML paliperidone palmitate 156 MG/ML Prefilled Syringe [Invega]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "858057", "drug_name": "0.75 ML paliperidone palmitate 156 MG/ML Prefilled Syringe [Invega]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "858074", "drug_name": "0.25 ML paliperidone palmitate 156 MG/ML Prefilled Syringe [Invega]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "858079", "drug_name": "levonorgestrel 1.5 MG Oral Tablet [Plan B One-Step]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "858262", "drug_name": "doxercalciferol 0.001 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "858625", "drug_name": "pramipexole dihydrochloride 0.75 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "858733", "drug_name": "ursodiol 500 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "858747", "drug_name": "ursodiol 300 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "858751", "drug_name": "ursodiol 250 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "858804", "drug_name": "enalapril maleate 2.5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "858810", "drug_name": "enalapril maleate 20 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "858813", "drug_name": "enalapril maleate 5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "858817", "drug_name": "enalapril maleate 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "858824", "drug_name": "enalapril maleate 5 MG / hydrochlorothiazide 12.5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "858828", "drug_name": "enalapril maleate 10 MG / hydrochlorothiazide 25 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "859033", "drug_name": "pramipexole dihydrochloride 0.125 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "859040", "drug_name": "pramipexole dihydrochloride 0.25 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "859044", "drug_name": "pramipexole dihydrochloride 0.5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "859048", "drug_name": "pramipexole dihydrochloride 1.5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "859052", "drug_name": "pramipexole dihydrochloride 1 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "859186", "drug_name": "selegiline hydrochloride 5 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "859193", "drug_name": "selegiline hydrochloride 5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "859419", "drug_name": "rosuvastatin calcium 40 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "859424", "drug_name": "rosuvastatin calcium 5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "859747", "drug_name": "rosuvastatin calcium 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "859751", "drug_name": "rosuvastatin calcium 20 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "859824", "drug_name": "fluphenazine decanoate 25 MG/ML Injectable Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "859835", "drug_name": "fluphenazine hydrochloride 0.5 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "859841", "drug_name": "fluphenazine hydrochloride 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "859867", "drug_name": "haloperidol decanoate 50 MG/ML Injectable Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "859871", "drug_name": "haloperidol decanoate 100 MG/ML Injectable Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "859975", "drug_name": "asenapine 10 MG Sublingual Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "859981", "drug_name": "asenapine 5 MG Sublingual Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "860055", "drug_name": "simethicone 180 MG Oral Capsule [Gas-X]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "860103", "drug_name": "ketorolac tromethamine 4 MG/ML Ophthalmic Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "860107", "drug_name": "ketorolac tromethamine 5 MG/ML Ophthalmic Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "860215", "drug_name": "megestrol acetate 20 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "860221", "drug_name": "megestrol acetate 40 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "860225", "drug_name": "megestrol acetate 40 MG/ML Oral Suspension", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "860695", "drug_name": "24 HR galantamine hydrobromide 16 MG Extended Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "860707", "drug_name": "24 HR galantamine hydrobromide 24 MG Extended Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "860715", "drug_name": "24 HR galantamine hydrobromide 8 MG Extended Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "860771", "drug_name": "trimethobenzamide hydrochloride 300 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "860805", "drug_name": "azelastine hydrochloride 0.5 MG/ML Ophthalmic Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "860901", "drug_name": "galantamine hydrobromide 4 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "860918", "drug_name": "fluphenazine hydrochloride 5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "860975", "drug_name": "24 HR metformin hydrochloride 500 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "860981", "drug_name": "24 HR metformin hydrochloride 750 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "861004", "drug_name": "metformin hydrochloride 1000 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "861007", "drug_name": "metformin hydrochloride 500 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "861010", "drug_name": "metformin hydrochloride 850 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "861064", "drug_name": "sertraline 20 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "861113", "drug_name": "vitamin B12 0.5 MG/ACTUAT Nasal Spray", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "861132", "drug_name": "24 HR alfuzosin hydrochloride 10 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "861156", "drug_name": "12 HR propafenone hydrochloride 225 MG Extended Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "861164", "drug_name": "12 HR propafenone hydrochloride 325 MG Extended Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "861171", "drug_name": "12 HR propafenone hydrochloride 425 MG Extended Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "861200", "drug_name": "brimonidine tartrate 2 MG/ML Ophthalmic Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "861208", "drug_name": "brimonidine tartrate 1.5 MG/ML Ophthalmic Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "861221", "drug_name": "24 HR amphetamine aspartate 2.5 MG / amphetamine sulfate 2.5 MG / dextroamphetamine saccharate 2.5 MG / dextroamphetamine sulfate 2.5 MG Extended Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "861223", "drug_name": "24 HR amphetamine aspartate 3.75 MG / amphetamine sulfate 3.75 MG / dextroamphetamine saccharate 3.75 MG / dextroamphetamine sulfate 3.75 MG Extended Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "861225", "drug_name": "24 HR amphetamine aspartate 5 MG / amphetamine sulfate 5 MG / dextroamphetamine saccharate 5 MG / dextroamphetamine sulfate 5 MG Extended Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "861227", "drug_name": "24 HR amphetamine aspartate 6.25 MG / amphetamine sulfate 6.25 MG / dextroamphetamine saccharate 6.25 MG / dextroamphetamine sulfate 6.25 MG Extended Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "861232", "drug_name": "24 HR amphetamine aspartate 7.5 MG / amphetamine sulfate 7.5 MG / dextroamphetamine saccharate 7.5 MG / dextroamphetamine sulfate 7.5 MG Extended Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, 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"quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "862006", "drug_name": "24 HR guanfacine 1 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "862013", "drug_name": "24 HR guanfacine 2 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "862019", "drug_name": "24 HR guanfacine 3 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "862025", "drug_name": "24 HR guanfacine 4 MG Extended 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"prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "863619", "drug_name": "24 HR oxybutynin chloride 10 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "863628", "drug_name": "24 HR oxybutynin chloride 15 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "863636", "drug_name": "24 HR oxybutynin chloride 5 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "863664", "drug_name": "oxybutynin chloride 5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "863669", "drug_name": "tamsulosin hydrochloride 0.4 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "864162", "drug_name": "tolnaftate 10 MG/ML Topical Solution [Tinaderm]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "864661", "drug_name": "efavirenz 600 MG / lamivudine 300 MG / tenofovir disoproxil fumarate 300 MG Oral Tablet", 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"prior_authorization": false, "step_therapy": true, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "864718", "drug_name": "methadone hydrochloride 5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": true, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "864761", "drug_name": "methadone hydrochloride 1 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": true, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "864769", "drug_name": "methadone hydrochloride 2 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": true, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "865098", "drug_name": "insulin lispro 100 UNT/ML Injectable Solution [Humalog]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "865117", "drug_name": "fluphenazine hydrochloride 1 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "865123", "drug_name": "fluphenazine hydrochloride 2.5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "865129", "drug_name": "fluphenazine hydrochloride 2.5 MG/ML Injectable Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "865208", "drug_name": "24 HR selegiline 0.25 MG/HR Transdermal System [Emsam]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "865212", "drug_name": "24 HR selegiline 0.375 MG/HR Transdermal System [Emsam]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "865216", "drug_name": "24 HR selegiline 0.5 MG/HR Transdermal System [Emsam]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "866018", "drug_name": "buspirone hydrochloride 15 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "866021", "drug_name": "cyproheptadine hydrochloride 0.4 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "866042", "drug_name": "neomycin sulfate 500 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "866083", "drug_name": "buspirone hydrochloride 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "866090", "drug_name": "buspirone hydrochloride 30 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "866094", "drug_name": "buspirone hydrochloride 5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "866103", "drug_name": "24 HR paliperidone 1.5 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "866111", "drug_name": "buspirone hydrochloride 7.5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "866144", "drug_name": "cyproheptadine hydrochloride 4 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "866412", "drug_name": "24 HR metoprolol succinate 100 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "866419", "drug_name": "24 HR metoprolol succinate 200 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "866427", "drug_name": "24 HR metoprolol succinate 25 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "866436", "drug_name": "24 HR metoprolol succinate 50 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "866479", "drug_name": "hydrochlorothiazide 25 MG / metoprolol tartrate 100 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "866482", "drug_name": "hydrochlorothiazide 25 MG / metoprolol tartrate 50 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "866491", "drug_name": "hydrochlorothiazide 50 MG / metoprolol tartrate 100 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "866511", "drug_name": "metoprolol tartrate 100 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "866514", "drug_name": "metoprolol tartrate 50 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "866924", "drug_name": "metoprolol tartrate 25 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "867502", "drug_name": "pazopanib 200 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "876193", "drug_name": "polyethylene glycol 3350 17000 MG Powder for Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "876195", "drug_name": "polyethylene glycol 3350 17000 MG Powder for Oral Solution [Miralax]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "876214", "drug_name": "polyethylene glycol 3350 17000 MG Powder for Oral Solution [Gavilax]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "877408", "drug_name": "ergocalciferol 0.2 MG/ML Oral Solution [Calcidol]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "877466", "drug_name": "ascorbic acid 60 MG / calcium pantothenate 10 MG / D-biotin 0.3 MG / folic acid 0.8 MG / niacinamide 20 MG / pyridoxine 10 MG / riboflavin 1.7 MG / thiamine 1.5 MG / vitamin B12 0.006 MG Oral Tablet [Rena-Vite]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "880340", "drug_name": "cholecalciferol 0.025 MG Chewable Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "880407", "drug_name": "polyethylene glycol 3350 17000 MG Powder for Oral Solution [ClearLax]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "881341", "drug_name": "adefovir dipivoxil 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "883826", "drug_name": "tranexamic acid 650 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "884173", "drug_name": "clonidine hydrochloride 0.1 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "884185", "drug_name": "clonidine hydrochloride 0.2 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "884189", "drug_name": "clonidine hydrochloride 0.3 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "884308", "drug_name": "nystatin 100 UNT/MG Topical Ointment", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "884385", "drug_name": "dextroamphetamine sulfate 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "884386", "drug_name": "dextroamphetamine sulfate 5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "884520", "drug_name": "dextroamphetamine sulfate 10 MG Extended Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "884532", "drug_name": "dextroamphetamine sulfate 15 MG Extended Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "884535", "drug_name": "dextroamphetamine sulfate 5 MG Extended Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "884707", "drug_name": "estradiol 0.01 MG Vaginal Insert", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "885209", "drug_name": "benztropine mesylate 2 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "885213", "drug_name": "benztropine mesylate 1 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "885219", "drug_name": "benztropine mesylate 0.5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "885578", "drug_name": "24 HR ferrous sulfate 142 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "885857", "drug_name": "balsalazide disodium 750 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "886662", "drug_name": "flecainide acetate 50 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "886666", "drug_name": "flecainide acetate 100 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "886671", "drug_name": "flecainide acetate 150 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "891297", "drug_name": "12 HR guaifenesin 1200 MG Extended Release Oral Tablet [Mucinex]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "891301", "drug_name": "12 HR guaifenesin 600 MG Extended Release Oral Tablet [Mucinex]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "891692", "drug_name": "cholecalciferol 0.357 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "891709", "drug_name": "ascorbic acid 60 MG / cuprous oxide 2 MG / dl-alpha tocopheryl acetate 30 MG / lutein 6 MG / zinc oxide 15 MG Oral Capsule [Ocuvite Lutein]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "891719", "drug_name": "ascorbic acid 200 MG / beta carotene 1000 UNT / cuprous oxide 2 MG / dl-alpha tocopheryl acetate 60 UNT / lutein 2 MG / sodium selenate 0.055 MG / zinc oxide 40 MG Oral Tablet [Ocuvite]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "891793", "drug_name": "ascorbic acid 226 MG / beta carotene 14320 UNT / cuprous oxide 0.8 MG / dl-alpha tocopheryl acetate 200 UNT / zinc oxide 34.8 MG Oral Capsule [PreserVision]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "891815", "drug_name": "ascorbic acid 113 MG / beta carotene 7160 MG / cuprous oxide 0.4 MG / dl-alpha tocopheryl acetate 100 UNT / zinc oxide 17.4 MG Oral Tablet [PreserVision]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "891820", "drug_name": "ascorbic acid 226 MG / cuprous oxide 0.8 MG / dl-alpha tocopheryl acetate 200 UNT / lutein 5 MG / zinc oxide 34.8 MG Oral Capsule [PreserVision with Lutein]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "891874", "drug_name": "morphine sulfate 100 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": true, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "891881", "drug_name": "morphine sulfate 15 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": true, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "891888", "drug_name": "morphine sulfate 30 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": true, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "891893", "drug_name": "morphine sulfate 60 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": true, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "892244", "drug_name": "{14 (24 HR nicotine 0.292 MG/HR Transdermal System) / 14 (24 HR nicotine 0.583 MG/HR Transdermal System) / 28 (24 HR nicotine 0.875 MG/HR Transdermal System) } Pack", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "892246", "drug_name": "levothyroxine sodium 0.1 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "892251", "drug_name": "levothyroxine sodium 0.2 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "892255", "drug_name": "levothyroxine sodium 0.3 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "892582", "drug_name": "morphine sulfate 15 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "892589", "drug_name": "morphine sulfate 2 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "892625", "drug_name": "morphine sulfate 20 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "892646", "drug_name": "morphine sulfate 200 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": true, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "892672", "drug_name": "morphine sulfate 30 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "894780", "drug_name": "morphine sulfate 4 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "895487", "drug_name": "fluticasone propionate 0.00005 MG/MG Topical Ointment", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "895670", "drug_name": "24 HR quetiapine 150 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "895987", "drug_name": "fluticasone propionate 0.5 MG/ML Topical Cream", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "895994", "drug_name": "120 ACTUAT fluticasone propionate 0.044 MG/ACTUAT Metered Dose Inhaler", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "895999", "drug_name": "120 ACTUAT fluticasone propionate 0.11 MG/ACTUAT Metered Dose Inhaler", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "896004", "drug_name": "120 ACTUAT fluticasone propionate 0.22 MG/ACTUAT Metered Dose Inhaler", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "896018", "drug_name": "60 ACTUAT fluticasone propionate 0.05 MG/ACTUAT Dry Powder Inhaler", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "896021", "drug_name": "60 ACTUAT fluticasone propionate 0.1 MG/ACTUAT Dry Powder Inhaler", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "896025", "drug_name": "60 ACTUAT fluticasone propionate 0.25 MG/ACTUAT Dry Powder Inhaler", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "896184", "drug_name": "60 ACTUAT fluticasone propionate 0.1 MG/ACTUAT / salmeterol 0.05 MG/ACTUAT Dry Powder Inhaler", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "896209", "drug_name": "60 ACTUAT fluticasone propionate 0.25 MG/ACTUAT / salmeterol 0.05 MG/ACTUAT Dry Powder Inhaler", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "896228", "drug_name": "60 ACTUAT fluticasone propionate 0.5 MG/ACTUAT / salmeterol 0.05 MG/ACTUAT Dry Powder Inhaler", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "896236", "drug_name": "120 ACTUAT fluticasone propionate 0.045 MG/ACTUAT / salmeterol 0.021 MG/ACTUAT Metered Dose Inhaler", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "896244", "drug_name": "120 ACTUAT fluticasone propionate 0.115 MG/ACTUAT / salmeterol 0.021 MG/ACTUAT Metered Dose Inhaler", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "896272", "drug_name": "120 ACTUAT fluticasone propionate 0.23 MG/ACTUAT / salmeterol 0.021 MG/ACTUAT Metered Dose Inhaler", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "896758", "drug_name": "labetalol hydrochloride 100 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "896762", 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"drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": true, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "897640", "drug_name": "verapamil hydrochloride 180 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "897649", "drug_name": "verapamil hydrochloride 240 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "897659", "drug_name": "verapamil hydrochloride 120 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "897696", "drug_name": "hydromorphone hydrochloride 2 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "897702", "drug_name": "hydromorphone hydrochloride 4 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "897710", "drug_name": "hydromorphone hydrochloride 8 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "898342", "drug_name": "amlodipine 10 MG / benazepril hydrochloride 20 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "898346", "drug_name": "amlodipine 10 MG / benazepril hydrochloride 40 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "898350", "drug_name": "amlodipine 2.5 MG / benazepril hydrochloride 10 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "898353", "drug_name": "amlodipine 5 MG / benazepril hydrochloride 10 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "898356", "drug_name": "amlodipine 5 MG / benazepril hydrochloride 20 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "898359", "drug_name": "amlodipine 5 MG / benazepril hydrochloride 40 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "898362", "drug_name": "benazepril hydrochloride 10 MG / hydrochlorothiazide 12.5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "898367", "drug_name": "benazepril hydrochloride 20 MG / hydrochlorothiazide 12.5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "898372", "drug_name": "benazepril hydrochloride 20 MG / hydrochlorothiazide 25 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "898490", "drug_name": "potassium citrate 15 MEQ Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "898687", 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"drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": true, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "898719", "drug_name": "benazepril hydrochloride 40 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "898723", "drug_name": "benazepril hydrochloride 5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "899518", "drug_name": "dexmethylphenidate hydrochloride 5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": 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"900891", "drug_name": "{7 (24 HR lamotrigine 100 MG Extended Release Oral Tablet [Lamictal]) / 14 (24 HR lamotrigine 25 MG Extended Release Oral Tablet [Lamictal]) / 14 (24 HR lamotrigine 50 MG Extended Release Oral Tablet [Lamictal]) } Pack [Lamictal XR Orange Patient Titration Kit (for Patients Not Taking Carbamazepine, Phenytoin, Phenobarbital, Primidone, or Valproate)]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "900984", "drug_name": "{21 (24 HR lamotrigine 25 MG Extended Release Oral Tablet [Lamictal]) / 7 (24 HR lamotrigine 50 MG Extended Release Oral Tablet [Lamictal]) } Pack [Lamictal XR Blue Patient Titration Kit (for Patients Taking Valproate)]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "901518", "drug_name": "0.5 ML Neisseria meningitidis serogroup A oligosaccharide diphtheria CRM197 protein conjugate vaccine 0.02 MG/ML / Neisseria meningitidis serogroup C oligosaccharide diphtheria CRM197 protein conjugate vaccine 0.01 MG/ML / Neisseria meningitidis serogroup W-135 oligosaccharide diphtheria CRM197 protein conjugate vaccine 0.01 MG/ML / Neisseria meningitidis serogroup Y oligosaccharide diphtheria CRM197 protein conjugate vaccine 0.01 MG/ML Injection [Menveo]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "903456", "drug_name": "liothyronine sodium 0.005 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "903697", "drug_name": "liothyronine sodium 0.025 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "903703", "drug_name": "liothyronine sodium 0.05 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "903841", "drug_name": "pyridostigmine bromide 30 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "903843", "drug_name": "pyridostigmine bromide 12 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "903847", "drug_name": "pyridostigmine bromide 180 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "903857", "drug_name": "pyridostigmine bromide 60 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "903873", "drug_name": "24 HR fluvoxamine maleate 100 MG Extended Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "903879", "drug_name": "24 HR fluvoxamine maleate 150 MG Extended Release Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "903884", "drug_name": "fluvoxamine maleate 100 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "903887", "drug_name": "fluvoxamine maleate 25 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "903891", "drug_name": "fluvoxamine maleate 50 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "904026", "drug_name": "loratadine 5 MG Disintegrating Oral Tablet [Claritin]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "904396", "drug_name": "alendronic acid 35 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "904419", "drug_name": "alendronic acid 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "904431", "drug_name": "alendronic acid 70 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "904458", "drug_name": "pravastatin sodium 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "904467", "drug_name": "pravastatin sodium 20 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "904475", "drug_name": "pravastatin sodium 40 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "904481", "drug_name": "pravastatin sodium 80 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "904589", "drug_name": "sotalol hydrochloride 240 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "905158", "drug_name": "sirolimus 0.5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, 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false, "years": [ 2026 ] } ] }, { "rxnorm_id": "966248", "drug_name": "levothyroxine sodium 0.112 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "966249", "drug_name": "levothyroxine sodium 0.175 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "966253", "drug_name": "levothyroxine sodium 0.088 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "966270", "drug_name": "levothyroxine sodium 0.137 MG Oral Tablet", "plans": [ { "plan_id_type": 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false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "966920", "drug_name": "polyethylene glycol 3350 236000 MG / potassium chloride 2970 MG / sodium bicarbonate 6740 MG / sodium chloride 5860 MG / sodium sulfate 22740 MG Powder for Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "967012", "drug_name": "polyethylene glycol 3350 236000 MG / potassium chloride 2970 MG / sodium bicarbonate 6740 MG / sodium chloride 5860 MG / sodium sulfate 22740 MG Powder for Oral Solution [Gavilyte-G]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "967023", "drug_name": "polyethylene glycol 3350 240000 MG / potassium chloride 2980 MG / 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} ] }, { "rxnorm_id": "977840", "drug_name": "3 ML insulin aspart protamine, human 70 UNT/ML / insulin aspart, human 30 UNT/ML Pen Injector [NovoLog Mix]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "977842", "drug_name": "insulin aspart protamine, human 70 UNT/ML / insulin aspart, human 30 UNT/ML Injectable Suspension [NovoLog Mix]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "977880", "drug_name": "amiloride hydrochloride 5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "977883", "drug_name": "amiloride hydrochloride 5 MG / hydrochlorothiazide 50 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "977978", "drug_name": "halobetasol propionate 0.0005 MG/MG Topical Ointment", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "977990", "drug_name": "halobetasol propionate 0.5 MG/ML Topical Cream", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "978001", "drug_name": "loperamide hydrochloride 2 MG / simethicone 125 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "978006", "drug_name": "loperamide hydrochloride 2 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "978010", "drug_name": "loperamide hydrochloride 2 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "978012", "drug_name": "loperamide hydrochloride 2 MG Oral Tablet [Diamode]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "978950", "drug_name": "{5 (dienogest 2 MG / estradiol valerate 2 MG Oral Tablet) / 17 (dienogest 3 MG / estradiol valerate 2 MG Oral Tablet) / 2 (estradiol valerate 1 MG Oral Tablet) / 2 (estradiol valerate 3 MG Oral Tablet) / 2 (inert ingredients 1 MG Oral Tablet) } Pack [Natazia 28 Day]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "979092", "drug_name": "hydroxychloroquine sulfate 200 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "979099", "drug_name": "polyethylene glycol 3350 420000 MG / potassium chloride 1480 MG / sodium bicarbonate 5720 MG / sodium chloride 11200 MG Powder for Oral Solution [GaviLyte-N]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "979464", "drug_name": "hydrochlorothiazide 12.5 MG / losartan potassium 100 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "979468", "drug_name": "hydrochlorothiazide 12.5 MG / losartan potassium 50 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "979471", "drug_name": "hydrochlorothiazide 25 MG / losartan potassium 100 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "979480", "drug_name": "losartan potassium 100 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "979485", "drug_name": "losartan potassium 25 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "979492", "drug_name": "losartan potassium 50 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "984105", "drug_name": "sodium phenylbutyrate 0.94 MG/MG Oral Powder", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "991039", "drug_name": "chlorpromazine hydrochloride 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "991044", "drug_name": "chlorpromazine hydrochloride 100 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "991053", "drug_name": "chlorpromazine hydrochloride 100 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "991061", "drug_name": "dicyclomine hydrochloride 10 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "991082", "drug_name": "dicyclomine hydrochloride 2 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "991086", "drug_name": "dicyclomine hydrochloride 20 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "991188", "drug_name": "chlorpromazine hydrochloride 200 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "991194", "drug_name": "chlorpromazine hydrochloride 25 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "991332", "drug_name": "chlorpromazine hydrochloride 30 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "991336", "drug_name": "chlorpromazine hydrochloride 50 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "991456", "drug_name": "ergocalciferol 400 UNT / vitamin A 10000 UNT Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "991486", "drug_name": "codeine phosphate 2 MG/ML / promethazine hydrochloride 1.25 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "991528", "drug_name": "dextromethorphan hydrobromide 3 MG/ML / promethazine hydrochloride 1.25 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "992432", "drug_name": "promethazine hydrochloride 1.25 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "992438", "drug_name": "promethazine hydrochloride 12.5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "992441", "drug_name": "promethazine hydrochloride 12.5 MG Rectal Suppository", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "992445", "drug_name": "promethazine hydrochloride 12.5 MG Rectal Suppository [Promethegan]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "992447", "drug_name": "promethazine hydrochloride 25 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "992454", "drug_name": "promethazine hydrochloride 25 MG Rectal Suppository", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "992459", "drug_name": "promethazine hydrochloride 25 MG Rectal Suppository [Promethegan]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "992475", "drug_name": "promethazine hydrochloride 50 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "992481", "drug_name": "promethazine hydrochloride 50 MG Rectal Suppository [Promethegan]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "992656", "drug_name": "homatropine methylbromide 1.5 MG / hydrocodone bitartrate 5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "992668", "drug_name": "homatropine methylbromide 0.3 MG/ML / hydrocodone bitartrate 1 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "992765", "drug_name": "miconazole nitrate 200 MG Vaginal Insert", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "992766", "drug_name": "{1 (9000 MG) (miconazole nitrate 20 MG/ML Vaginal Cream) / 3 (miconazole nitrate 200 MG Vaginal Insert) } Pack", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "992771", "drug_name": "{1 (9000 MG) (miconazole nitrate 20 MG/ML Vaginal Cream [Monistat]) / 3 (miconazole nitrate 200 MG Vaginal Insert [Monistat]) } Pack [Monistat 3 Day Ovule Combination Pack]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "992775", "drug_name": "{1 (miconazole nitrate 1200 MG Vaginal Insert) / 1 (9000 MG) (miconazole nitrate 20 MG/ML Vaginal Cream) } Pack", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "992778", "drug_name": "{1 (miconazole nitrate 1200 MG Vaginal Insert [Monistat]) / 1 (9000 MG) (miconazole nitrate 20 MG/ML Vaginal Cream [Monistat]) } Pack [Monistat 1 Day Ovule Combination Pack]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "992816", "drug_name": "{1 (9000 MG) (miconazole nitrate 20 MG/ML Vaginal Cream) / 3 (5000 MG) (miconazole nitrate 40 MG/ML Vaginal Cream) } Pack", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "993462", "drug_name": "midodrine hydrochloride 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "993466", "drug_name": "midodrine hydrochloride 2.5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "993470", "drug_name": "midodrine hydrochloride 5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "993503", "drug_name": "12 HR bupropion hydrochloride 100 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "993518", "drug_name": "12 HR bupropion hydrochloride 150 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "993536", "drug_name": "12 HR bupropion hydrochloride 200 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "993541", "drug_name": "24 HR bupropion hydrochloride 150 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "993552", "drug_name": "24 HR bupropion hydrobromide 174 MG Extended Release Oral Tablet [Aplenzin]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "993557", "drug_name": "24 HR bupropion hydrochloride 300 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "993569", "drug_name": "24 HR bupropion hydrobromide 348 MG Extended Release Oral Tablet [Aplenzin]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "993683", "drug_name": "24 HR bupropion hydrobromide 522 MG Extended Release Oral Tablet [Aplenzin]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "993687", "drug_name": "bupropion hydrochloride 100 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "993691", "drug_name": "bupropion hydrochloride 75 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "993755", "drug_name": "acetaminophen 24 MG/ML / codeine phosphate 2.4 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "993770", "drug_name": "acetaminophen 300 MG / codeine phosphate 15 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "993781", "drug_name": "acetaminophen 300 MG / codeine phosphate 30 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "993856", "drug_name": "lacosamide 10 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "993890", "drug_name": "acetaminophen 300 MG / codeine phosphate 60 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "994521", "drug_name": "12 HR orphenadrine citrate 100 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "994537", "drug_name": "aspirin 770 MG / caffeine 60 MG / orphenadrine citrate 50 MG Oral Tablet [Norgesic]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "994539", "drug_name": "aspirin 770 MG / caffeine 60 MG / orphenadrine citrate 50 MG Oral Tablet [Orphengesic]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "995218", "drug_name": "hydroxyzine hydrochloride 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "995232", "drug_name": "hydroxyzine pamoate 100 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "995241", "drug_name": "hydroxyzine hydrochloride 2 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] 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"22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "995281", "drug_name": "hydroxyzine hydrochloride 50 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "995599", "drug_name": "ethambutol hydrochloride 100 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "995607", "drug_name": "ethambutol hydrochloride 400 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] 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"HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "995726", "drug_name": "meclizine hydrochloride 25 MG Oral Tablet [Dramamine Less Drowsy]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "995868", "drug_name": "codeine phosphate 2 MG/ML / guaifenesin 20 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": true, "years": [ 2026 ] } ] }, { "rxnorm_id": "996520", "drug_name": "dextromethorphan hydrobromide 2 MG/ML / guaifenesin 20 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "996559", "drug_name": "1 ML somatropin 12 MG/ML Cartridge [Genotropin]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "996561", "drug_name": "memantine hydrochloride 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "996571", "drug_name": "memantine hydrochloride 5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "996572", "drug_name": "{21 (memantine hydrochloride 10 MG Oral Tablet) / 28 (memantine hydrochloride 5 MG Oral Tablet) } Pack", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "996740", "drug_name": "memantine hydrochloride 2 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "996921", "drug_name": "clozapine 200 MG Disintegrating Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "997220", "drug_name": "donepezil hydrochloride 10 MG Disintegrating Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "997223", "drug_name": "donepezil hydrochloride 10 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "997226", "drug_name": "donepezil hydrochloride 5 MG Disintegrating Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "997229", "drug_name": "donepezil hydrochloride 5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "997406", "drug_name": "12 HR fexofenadine hydrochloride 60 MG / pseudoephedrine hydrochloride 120 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "997415", "drug_name": "24 HR fexofenadine hydrochloride 180 MG / pseudoephedrine hydrochloride 240 MG Extended Release Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "997420", "drug_name": "fexofenadine hydrochloride 180 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "997422", "drug_name": "fexofenadine hydrochloride 180 MG Oral Tablet [Allegra]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "997484", "drug_name": "fexofenadine hydrochloride 30 MG Disintegrating Oral Tablet [Allegra]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "BRAND", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "997491", "drug_name": "fexofenadine hydrochloride 6 MG/ML Oral Suspension", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "997493", "drug_name": "fexofenadine hydrochloride 6 MG/ML Oral Suspension [Allegra]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "997501", "drug_name": "fexofenadine hydrochloride 60 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "997502", "drug_name": "fexofenadine hydrochloride 60 MG Oral Tablet [Allegra]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "997512", "drug_name": "12 HR fexofenadine hydrochloride 60 MG / pseudoephedrine hydrochloride 120 MG Extended Release Oral Tablet [Allegra-D]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "997515", "drug_name": "24 HR fexofenadine hydrochloride 180 MG / pseudoephedrine hydrochloride 240 MG Extended Release Oral Tablet [Allegra-D]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "997653", "drug_name": "nilotinib 150 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "998189", "drug_name": "everolimus 2.5 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": true, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "998460", "drug_name": "miconazole nitrate 0.02 MG/MG Topical Ointment [Triple Paste AF]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "998461", "drug_name": "miconazole nitrate 0.02 MG/MG Topical Powder", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "998483", "drug_name": "miconazole nitrate 20 MG/ML Topical Cream", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "998501", "drug_name": "miconazole nitrate 20 MG/ML Topical Cream [Micaderm]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "998540", "drug_name": "miconazole nitrate 20 MG/ML Vaginal Cream", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "998541", "drug_name": "miconazole nitrate 20 MG/ML Vaginal Cream [Monistat]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "998544", "drug_name": "miconazole nitrate 40 MG/ML Vaginal Cream", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "998546", "drug_name": "miconazole nitrate 40 MG/ML Vaginal Cream [Monistat]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "998666", "drug_name": "carboxymethylcellulose sodium 0.01 MG/MG Ophthalmic Gel [TheraTears]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "998671", "drug_name": "168 HR clonidine 0.00417 MG/HR Transdermal System", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "998675", "drug_name": "168 HR clonidine 0.00833 MG/HR Transdermal System", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "998679", "drug_name": "168 HR clonidine 0.0125 MG/HR Transdermal System", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "998685", "drug_name": "acebutolol 400 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "998689", "drug_name": "acebutolol 200 MG Oral Capsule", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "998704", "drug_name": "calcium carbonate 500 MG Chewable Tablet [Cal Gest]", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "998740", "drug_name": "docusate sodium 50 MG / sennosides, USP 8.6 MG Oral Tablet", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] }, { "rxnorm_id": "999961", "drug_name": "glycopyrrolate 0.2 MG/ML Oral Solution", "plans": [ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "22780AA1111111", "drug_tier": "GENERIC", "prior_authorization": false, "step_therapy": false, "quantity_limit": false, "years": [ 2026 ] } ] } ]