[ {
  "rxnorm_id" : "1000048",
  "drug_name" : "DOXEPIN 10 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1000054",
  "drug_name" : "DOXEPIN 10 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1000058",
  "drug_name" : "DOXEPIN 100 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1000064",
  "drug_name" : "DOXEPIN 150 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1000070",
  "drug_name" : "DOXEPIN 25 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1000076",
  "drug_name" : "DOXEPIN 50 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1000097",
  "drug_name" : "DOXEPIN 75 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1000114",
  "drug_name" : "MEDROXYPROGESTERONE ACETATE 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1000126",
  "drug_name" : "1 ML MEDROXYPROGESTERONE ACETATE 150 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1000135",
  "drug_name" : "MEDROXYPROGESTERONE ACETATE 2.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1000141",
  "drug_name" : "MEDROXYPROGESTERONE ACETATE 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1000153",
  "drug_name" : "1 ML MEDROXYPROGESTERONE ACETATE 150 MG\\/ML PREFILLED SYRINGE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1000158",
  "drug_name" : "0.65 ML MEDROXYPROGESTERONE ACETATE 160 MG\\/ML PREFILLED SYRINGE [DEPO-SUBQ PROVERA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1000405",
  "drug_name" : "NORETHINDRONE ACETATE 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1000647",
  "drug_name" : "PILOCARPINE HYDROCHLORIDE 10 MG\\/ML OPHTHALMIC SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1000862",
  "drug_name" : "PILOCARPINE HYDROCHLORIDE 20 MG\\/ML OPHTHALMIC SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1000897",
  "drug_name" : "PILOCARPINE HYDROCHLORIDE 40 MG\\/ML OPHTHALMIC SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1000913",
  "drug_name" : "PILOCARPINE HYDROCHLORIDE 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1001689",
  "drug_name" : "{2 (480 ML) (MAGNESIUM SULFATE 0.0277 MEQ\\/ML \\/ POTASSIUM SULFATE 0.0374 MEQ\\/ML \\/ SODIUM SULFATE 0.257 MEQ\\/ML ORAL SOLUTION) } PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1001690",
  "drug_name" : "SUPREP BOWEL PREP KIT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1006120",
  "drug_name" : "SULFACETAMIDE SODIUM 100 MG\\/ML OPHTHALMIC SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1006608",
  "drug_name" : "24 HR DEXMETHYLPHENIDATE HYDROCHLORIDE 40 MG EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1006688",
  "drug_name" : "SULFACETAMIDE SODIUM 100 MG\\/ML TOPICAL LOTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1006801",
  "drug_name" : "CLOZAPINE 150 MG DISINTEGRATING ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "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" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1009147",
  "drug_name" : "AMPHETAMINE ASPARTATE 1.875 MG \\/ AMPHETAMINE SULFATE 1.875 MG \\/ DEXTROAMPHETAMINE SACCHARATE 1.875 MG \\/ DEXTROAMPHETAMINE SULFATE 1.875 MG ORAL TABLET [ADDERALL]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1010033",
  "drug_name" : "LIDOCAINE HYDROCHLORIDE 10 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1010671",
  "drug_name" : "LIDOCAINE HYDROCHLORIDE 20 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1010688",
  "drug_name" : "20 ML EPINEPHRINE 0.005 MG\\/ML \\/ LIDOCAINE HYDROCHLORIDE 20 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1010739",
  "drug_name" : "LIDOCAINE HYDROCHLORIDE 20 MG\\/ML MUCOUS MEMBRANE TOPICAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1010745",
  "drug_name" : "EPINEPHRINE 0.005 MG\\/ML \\/ LIDOCAINE HYDROCHLORIDE 5 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1010751",
  "drug_name" : "EPINEPHRINE 0.01 MG\\/ML \\/ LIDOCAINE HYDROCHLORIDE 10 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1010759",
  "drug_name" : "EPINEPHRINE 0.01 MG\\/ML \\/ LIDOCAINE HYDROCHLORIDE 20 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1010844",
  "drug_name" : "5 ML LIDOCAINE HYDROCHLORIDE 40 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1010878",
  "drug_name" : "LIDOCAINE HYDROCHLORIDE 40 MG\\/ML MUCOUS MEMBRANE TOPICAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1010900",
  "drug_name" : "LIDOCAINE HYDROCHLORIDE 5 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1011648",
  "drug_name" : "1.7 ML ARTICAINE HYDROCHLORIDE 40 MG\\/ML \\/ EPINEPHRINE 0.01 MG\\/ML CARTRIDGE [ARTICADENT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1011736",
  "drug_name" : "ALISKIREN 150 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1011739",
  "drug_name" : "ALISKIREN 300 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1011852",
  "drug_name" : "LIDOCAINE HYDROCHLORIDE 0.02 MG\\/MG TOPICAL GEL",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1012021",
  "drug_name" : "PREDNISOLONE SODIUM PHOSPHATE 2.5 MG\\/ML \\/ SULFACETAMIDE SODIUM 100 MG\\/ML OPHTHALMIC SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1012066",
  "drug_name" : "5 ML LIDOCAINE HYDROCHLORIDE 10 MG\\/ML PREFILLED SYRINGE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1012068",
  "drug_name" : "5 ML LIDOCAINE HYDROCHLORIDE 20 MG\\/ML PREFILLED SYRINGE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1012377",
  "drug_name" : "BUPIVACAINE HYDROCHLORIDE 2.5 MG\\/ML \\/ EPINEPHRINE 0.005 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1012384",
  "drug_name" : "BUPIVACAINE HYDROCHLORIDE 5 MG\\/ML \\/ EPINEPHRINE 0.005 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1012404",
  "drug_name" : "BUPIVACAINE HYDROCHLORIDE 5 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1012413",
  "drug_name" : "BUPIVACAINE HYDROCHLORIDE 2.5 MG\\/ML \\/ EPINEPHRINE 0.005 MG\\/ML INJECTABLE SOLUTION [SENSORCAINE WITH EPINEPHRINE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1012417",
  "drug_name" : "BUPIVACAINE HYDROCHLORIDE 5 MG\\/ML \\/ EPINEPHRINE 0.005 MG\\/ML INJECTABLE SOLUTION [SENSORCAINE WITH EPINEPHRINE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1012457",
  "drug_name" : "BUPIVACAINE HYDROCHLORIDE 5 MG\\/ML INJECTABLE SOLUTION [SENSORCAINE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1012726",
  "drug_name" : "MEPIVACAINE HYDROCHLORIDE 10 MG\\/ML INJECTABLE SOLUTION [POLOCAINE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1012735",
  "drug_name" : "30 ML MEPIVACAINE HYDROCHLORIDE 15 MG\\/ML INJECTION [POLOCAINE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1012741",
  "drug_name" : "MEPIVACAINE HYDROCHLORIDE 20 MG\\/ML INJECTABLE SOLUTION [POLOCAINE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1012895",
  "drug_name" : "FINGOLIMOD 0.5 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1014314",
  "drug_name" : "TRIAMCINOLONE ACETONIDE 1 MG\\/ML TOPICAL CREAM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "103401",
  "drug_name" : "HYDROCORTISONE 0.025 MG\\/MG TOPICAL OINTMENT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "103456",
  "drug_name" : "FLUOCINONIDE 0.5 MG\\/ML TOPICAL CREAM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "103457",
  "drug_name" : "FLUOCINONIDE 0.0005 MG\\/MG TOPICAL OINTMENT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1037045",
  "drug_name" : "DABIGATRAN ETEXILATE 150 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1037049",
  "drug_name" : "DABIGATRAN ETEXILATE 150 MG ORAL CAPSULE [PRADAXA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1037179",
  "drug_name" : "DABIGATRAN ETEXILATE 75 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1037181",
  "drug_name" : "DABIGATRAN ETEXILATE 75 MG ORAL CAPSULE [PRADAXA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "103968",
  "drug_name" : "LAMOTRIGINE 100 MG DISINTEGRATING ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1040016",
  "drug_name" : "CEFTAROLINE FOSAMIL 600 MG INJECTION [TEFLARO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1040025",
  "drug_name" : "CORTICOTROPIN 80 UNT\\/ML INJECTABLE SOLUTION [ACTHAR]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1040031",
  "drug_name" : "LURASIDONE HYDROCHLORIDE 40 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1040041",
  "drug_name" : "LURASIDONE HYDROCHLORIDE 80 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1040058",
  "drug_name" : "DEXTROMETHORPHAN HYDROBROMIDE 20 MG \\/ QUINIDINE SULFATE 10 MG ORAL CAPSULE [NUEDEXTA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1041518",
  "drug_name" : "AZELAIC ACID 0.15 MG\\/MG TOPICAL GEL",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "104208",
  "drug_name" : "2 ML DIGOXIN 0.25 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1044427",
  "drug_name" : "ACETAMINOPHEN 20 MG\\/ML \\/ HYDROCODONE BITARTRATE 0.667 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1044591",
  "drug_name" : "TESAMORELIN 2 MG INJECTION [EGRIFTA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1045402",
  "drug_name" : "DASATINIB 140 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1045406",
  "drug_name" : "DASATINIB 80 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1045456",
  "drug_name" : "2 ML ERIBULIN MESYLATE 0.5 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1046920",
  "drug_name" : "NICOTINE 4 MG INHALATION SOLUTION [NICOTROL]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1048445",
  "drug_name" : "COLESTIPOL HYDROCHLORIDE 1000 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1048450",
  "drug_name" : "COLESTIPOL HYDROCHLORIDE 5000 MG GRANULES FOR ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "104884",
  "drug_name" : "METOCLOPRAMIDE 1 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "104894",
  "drug_name" : "ONDANSETRON 4 MG DISINTEGRATING ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1049214",
  "drug_name" : "ACETAMINOPHEN 325 MG \\/ OXYCODONE HYDROCHLORIDE 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1049221",
  "drug_name" : "ACETAMINOPHEN 325 MG \\/ OXYCODONE HYDROCHLORIDE 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1049223",
  "drug_name" : "ACETAMINOPHEN 325 MG \\/ OXYCODONE HYDROCHLORIDE 5 MG ORAL TABLET [ENDOCET]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1049225",
  "drug_name" : "ACETAMINOPHEN 325 MG \\/ OXYCODONE HYDROCHLORIDE 7.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1049227",
  "drug_name" : "ACETAMINOPHEN 325 MG \\/ OXYCODONE HYDROCHLORIDE 7.5 MG ORAL TABLET [ENDOCET]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1049604",
  "drug_name" : "OXYCODONE HYDROCHLORIDE 1 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1049611",
  "drug_name" : "OXYCODONE HYDROCHLORIDE 15 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1049615",
  "drug_name" : "OXYCODONE HYDROCHLORIDE 20 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1049618",
  "drug_name" : "OXYCODONE HYDROCHLORIDE 30 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1049621",
  "drug_name" : "OXYCODONE HYDROCHLORIDE 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1049625",
  "drug_name" : "ACETAMINOPHEN 325 MG \\/ OXYCODONE HYDROCHLORIDE 10 MG ORAL TABLET [PERCOCET]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1049633",
  "drug_name" : "DIPHENHYDRAMINE HYDROCHLORIDE 50 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1049642",
  "drug_name" : "ACETAMINOPHEN 325 MG \\/ OXYCODONE HYDROCHLORIDE 7.5 MG ORAL TABLET [PERCOCET]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1049683",
  "drug_name" : "OXYCODONE HYDROCHLORIDE 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1049686",
  "drug_name" : "OXYCODONE HYDROCHLORIDE 20 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1052658",
  "drug_name" : "ETRAVIRINE 200 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "105292",
  "drug_name" : "ISONIAZID 10 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1053697",
  "drug_name" : "NYSTATIN 100 UNT\\/MG \\/ TRIAMCINOLONE ACETONIDE 0.001 MG\\/MG TOPICAL OINTMENT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1053753",
  "drug_name" : "NYSTATIN 100000 UNT\\/ML \\/ TRIAMCINOLONE ACETONIDE 1 MG\\/ML TOPICAL CREAM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "105398",
  "drug_name" : "HYDROCORTISONE 100 MG INJECTION [SOLU-CORTEF]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "105553",
  "drug_name" : "CHLORAMBUCIL 2 MG ORAL TABLET [LEUKERAN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "105583",
  "drug_name" : "FLUOROURACIL 50 MG\\/ML TOPICAL CREAM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "105585",
  "drug_name" : "METHOTREXATE 2.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "105590",
  "drug_name" : "THIOGUANINE 40 MG ORAL TABLET [TABLOID]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "106302",
  "drug_name" : "TRETINOIN 0.25 MG\\/ML TOPICAL CREAM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "106303",
  "drug_name" : "TRETINOIN 0.5 MG\\/ML TOPICAL CREAM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "106336",
  "drug_name" : "KETOCONAZOLE 20 MG\\/ML MEDICATED SHAMPOO",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "106346",
  "drug_name" : "MUPIROCIN 0.02 MG\\/MG TOPICAL OINTMENT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "106351",
  "drug_name" : "SILVER SULFADIAZINE 10 MG\\/ML TOPICAL CREAM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "106387",
  "drug_name" : "PERMETHRIN 50 MG\\/ML TOPICAL CREAM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "106892",
  "drug_name" : "INSULIN ISOPHANE, HUMAN 70 UNT\\/ML \\/ INSULIN, REGULAR, HUMAN 30 UNT\\/ML INJECTABLE SUSPENSION [HUMULIN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "108396",
  "drug_name" : "20 ML ZIDOVUDINE 10 MG\\/ML INJECTION [RETROVIR]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "108515",
  "drug_name" : "1 ML TACROLIMUS 5 MG\\/ML INJECTION [PROGRAF]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1085633",
  "drug_name" : "TRIAMCINOLONE ACETONIDE 0.00025 MG\\/MG TOPICAL OINTMENT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1085636",
  "drug_name" : "TRIAMCINOLONE ACETONIDE 0.001 MG\\/MG TOPICAL OINTMENT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1085640",
  "drug_name" : "TRIAMCINOLONE ACETONIDE 0.005 MG\\/MG TOPICAL OINTMENT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1085644",
  "drug_name" : "TRIAMCINOLONE ACETONIDE 0.25 MG\\/ML TOPICAL CREAM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1085686",
  "drug_name" : "TRIAMCINOLONE ACETONIDE 5 MG\\/ML TOPICAL CREAM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1085728",
  "drug_name" : "TRIAMCINOLONE ACETONIDE 0.001 MG\\/MG ORAL PASTE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1085736",
  "drug_name" : "TRIAMCINOLONE ACETONIDE 0.147 MG\\/ML TOPICAL SPRAY",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1085741",
  "drug_name" : "TRIAMCINOLONE ACETONIDE 0.25 MG\\/ML TOPICAL LOTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1085745",
  "drug_name" : "TRIAMCINOLONE ACETONIDE 1 MG\\/ML TOPICAL LOTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1085752",
  "drug_name" : "TRIAMCINOLONE ACETONIDE 10 MG\\/ML INJECTABLE SUSPENSION [KENALOG]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1086772",
  "drug_name" : "VILAZODONE HYDROCHLORIDE 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1086778",
  "drug_name" : "VILAZODONE HYDROCHLORIDE 20 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1086784",
  "drug_name" : "VILAZODONE HYDROCHLORIDE 40 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1090639",
  "drug_name" : "[CLINIMIX E 4.25\\/10]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1090996",
  "drug_name" : "ETHINYL ESTRADIOL 0.005 MG \\/ NORETHINDRONE ACETATE 1 MG ORAL TABLET [JINTELI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1091145",
  "drug_name" : "8 HR METHYLPHENIDATE HYDROCHLORIDE 10 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1091150",
  "drug_name" : "METHYLPHENIDATE HYDROCHLORIDE 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1091155",
  "drug_name" : "24 HR METHYLPHENIDATE HYDROCHLORIDE 18 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1091170",
  "drug_name" : "24 HR METHYLPHENIDATE HYDROCHLORIDE 27 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1091185",
  "drug_name" : "24 HR METHYLPHENIDATE HYDROCHLORIDE 36 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1091210",
  "drug_name" : "24 HR METHYLPHENIDATE HYDROCHLORIDE 54 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1091225",
  "drug_name" : "8 HR METHYLPHENIDATE HYDROCHLORIDE 20 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1091341",
  "drug_name" : "METHYLPHENIDATE HYDROCHLORIDE 1 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1091389",
  "drug_name" : "METHYLPHENIDATE HYDROCHLORIDE 2.5 MG CHEWABLE TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1091392",
  "drug_name" : "METHYLPHENIDATE HYDROCHLORIDE 20 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1091497",
  "drug_name" : "METHYLPHENIDATE HYDROCHLORIDE 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1091839",
  "drug_name" : "ROFLUMILAST 0.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1092357",
  "drug_name" : "RUFINAMIDE 40 MG\\/ML ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1093280",
  "drug_name" : "DOCETAXEL 10 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1095229",
  "drug_name" : "FLAVOXATE HYDROCHLORIDE 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1095362",
  "drug_name" : "BALZIVA 28 DAY PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1095712",
  "drug_name" : "24 HR NEVIRAPINE 400 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1098141",
  "drug_name" : "24 HR NIACIN 500 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1098608",
  "drug_name" : "24 HR LAMOTRIGINE 300 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1098649",
  "drug_name" : "NEFAZODONE HYDROCHLORIDE 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1098666",
  "drug_name" : "NEFAZODONE HYDROCHLORIDE 150 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1098670",
  "drug_name" : "NEFAZODONE HYDROCHLORIDE 200 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1098674",
  "drug_name" : "NEFAZODONE HYDROCHLORIDE 250 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1098678",
  "drug_name" : "NEFAZODONE HYDROCHLORIDE 50 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1099288",
  "drug_name" : "DESIPRAMINE HYDROCHLORIDE 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1099292",
  "drug_name" : "DESIPRAMINE HYDROCHLORIDE 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1099296",
  "drug_name" : "DESIPRAMINE HYDROCHLORIDE 150 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1099300",
  "drug_name" : "DESIPRAMINE HYDROCHLORIDE 25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1099304",
  "drug_name" : "DESIPRAMINE HYDROCHLORIDE 50 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1099316",
  "drug_name" : "DESIPRAMINE HYDROCHLORIDE 75 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1099563",
  "drug_name" : "24 HR DIVALPROEX SODIUM 250 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1099569",
  "drug_name" : "24 HR DIVALPROEX SODIUM 500 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1099596",
  "drug_name" : "DIVALPROEX SODIUM 125 MG DELAYED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1099625",
  "drug_name" : "DIVALPROEX SODIUM 125 MG DELAYED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1099648",
  "drug_name" : "5 ML VALPROIC ACID 100 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1099678",
  "drug_name" : "DIVALPROEX SODIUM 250 MG DELAYED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1099681",
  "drug_name" : "VALPROIC ACID 250 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1099687",
  "drug_name" : "VALPROIC ACID 50 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1099808",
  "drug_name" : "CALCIUM ACETATE 133 MG\\/ML ORAL SOLUTION [PHOSLYRA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1099870",
  "drug_name" : "DIVALPROEX SODIUM 500 MG DELAYED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1100075",
  "drug_name" : "ABIRATERONE ACETATE 250 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1100706",
  "drug_name" : "LINAGLIPTIN 5 MG ORAL TABLET [TRADJENTA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1101926",
  "drug_name" : "24 HR DEXMETHYLPHENIDATE HYDROCHLORIDE 25 MG EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1101932",
  "drug_name" : "24 HR DEXMETHYLPHENIDATE HYDROCHLORIDE 35 MG EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1102277",
  "drug_name" : "RILPIVIRINE 25 MG ORAL TABLET [EDURANT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1111011",
  "drug_name" : "ETONOGESTREL 68 MG DRUG IMPLANT [NEXPLANON]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1111018",
  "drug_name" : "SAPROPTERIN DIHYDROCHLORIDE 100 MG POWDER FOR ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1111106",
  "drug_name" : "FIDAXOMICIN 200 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1111110",
  "drug_name" : "FIDAXOMICIN 200 MG ORAL TABLET [DIFICID]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1112980",
  "drug_name" : "BELATACEPT 250 MG INJECTION [NULOJIX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1113046",
  "drug_name" : "AMYLASE 15000 UNT \\/ LIPASE 3000 UNT \\/ PROTEASE 9500 UNT DELAYED RELEASE ORAL CAPSULE [CREON]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1114074",
  "drug_name" : "VANDETANIB 100 MG ORAL TABLET [CAPRELSA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1114085",
  "drug_name" : "100 ML ZOLEDRONIC ACID 0.04 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1114096",
  "drug_name" : "VANDETANIB 300 MG ORAL TABLET [CAPRELSA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1114202",
  "drug_name" : "RIVAROXABAN 10 MG ORAL TABLET [XARELTO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1114466",
  "drug_name" : "NITROGLYCERIN 0.004 MG\\/MG RECTAL OINTMENT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1115259",
  "drug_name" : "1.5 ML LEUPROLIDE ACETATE 30 MG\\/ML PREFILLED SYRINGE [LUPRON]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1115267",
  "drug_name" : "LEVOTHYROXINE SODIUM 0.1 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1115269",
  "drug_name" : "LEVOTHYROXINE SODIUM 0.2 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1115449",
  "drug_name" : "1 ML LEUPROLIDE ACETATE 11.25 MG\\/ML PREFILLED SYRINGE [LUPRON]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1115456",
  "drug_name" : "1 ML LEUPROLIDE ACETATE 15 MG\\/ML PREFILLED SYRINGE [LUPRON]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1115459",
  "drug_name" : "1 ML LEUPROLIDE ACETATE 3.75 MG\\/ML PREFILLED SYRINGE [LUPRON]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1115464",
  "drug_name" : "1 ML LEUPROLIDE ACETATE 7.5 MG\\/ML PREFILLED SYRINGE [LUPRON]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1115468",
  "drug_name" : "1.5 ML LEUPROLIDE ACETATE 15 MG\\/ML PREFILLED SYRINGE [LUPRON]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1115473",
  "drug_name" : "1.5 ML LEUPROLIDE ACETATE 7.5 MG\\/ML PREFILLED SYRINGE [LUPRON]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1115698",
  "drug_name" : "OSELTAMIVIR 6 MG\\/ML ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "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" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1116635",
  "drug_name" : "TICAGRELOR 90 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1116758",
  "drug_name" : "CHLOROQUINE PHOSPHATE 500 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1116927",
  "drug_name" : "DEXAMETHASONE PHOSPHATE 4 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1117522",
  "drug_name" : "COLISTIN 75 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1117531",
  "drug_name" : "CHLOROQUINE PHOSPHATE 250 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1119400",
  "drug_name" : "EVEROLIMUS 7.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "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" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1145932",
  "drug_name" : "1 ML ABATACEPT 125 MG\\/ML PREFILLED SYRINGE [ORENCIA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1146690",
  "drug_name" : "24 HR LAMOTRIGINE 250 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1147228",
  "drug_name" : "VEMURAFENIB 240 MG ORAL TABLET [ZELBORAF]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1147334",
  "drug_name" : "EMTRICITABINE 200 MG \\/ RILPIVIRINE 25 MG \\/ TENOFOVIR DISOPROXIL FUMARATE 300 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1148141",
  "drug_name" : "3 ML ICATIBANT 10 MG\\/ML PREFILLED SYRINGE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1148502",
  "drug_name" : "CRIZOTINIB 200 MG ORAL CAPSULE [XALKORI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1148506",
  "drug_name" : "CRIZOTINIB 250 MG ORAL CAPSULE [XALKORI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1149373",
  "drug_name" : "12 HR TAPENTADOL 200 MG EXTENDED RELEASE ORAL TABLET [NUCYNTA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1149617",
  "drug_name" : "COLLAGENASE 0.25 UNT\\/MG TOPICAL OINTMENT [SANTYL]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1149632",
  "drug_name" : "84 HR ESTRADIOL 0.00313 MG\\/HR TRANSDERMAL SYSTEM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1150836",
  "drug_name" : "LEVOBUNOLOL HYDROCHLORIDE 5 MG\\/ML OPHTHALMIC SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1189640",
  "drug_name" : "[TROPHAMINE 10 %]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1190110",
  "drug_name" : "FLUOXETINE 60 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1190225",
  "drug_name" : "120 ACTUAT ALBUTEROL 0.1 MG\\/ACTUAT \\/ IPRATROPIUM BROMIDE 0.02 MG\\/ACTUAT INHALATION SPRAY [COMBIVENT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1190546",
  "drug_name" : "10 ML ATROPINE SULFATE 0.1 MG\\/ML PREFILLED SYRINGE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1190568",
  "drug_name" : "ATROPINE SULFATE 0.005 MG\\/ML \\/ DIPHENOXYLATE HYDROCHLORIDE 0.5 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1190572",
  "drug_name" : "ATROPINE SULFATE 0.025 MG \\/ DIPHENOXYLATE HYDROCHLORIDE 2.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1190655",
  "drug_name" : "ATROPINE SULFATE 10 MG\\/ML OPHTHALMIC SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1190776",
  "drug_name" : "ATROPINE SULFATE 0.4 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1190916",
  "drug_name" : "0.5 ML DIPHTHERIA TOXOID VACCINE, INACTIVATED 4 UNT\\/ML \\/ TETANUS TOXOID VACCINE, INACTIVATED 10 UNT\\/ML INJECTION [TENIVAC]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1190919",
  "drug_name" : "0.5 ML DIPHTHERIA TOXOID VACCINE, INACTIVATED 4 UNT\\/ML \\/ TETANUS TOXOID VACCINE, INACTIVATED 10 UNT\\/ML PREFILLED SYRINGE [TENIVAC]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1191013",
  "drug_name" : "PROPARACAINE HYDROCHLORIDE 5 MG\\/ML OPHTHALMIC SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1191222",
  "drug_name" : "NALOXONE HYDROCHLORIDE 0.4 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1191234",
  "drug_name" : "1 ML NALOXONE HYDROCHLORIDE 0.4 MG\\/ML CARTRIDGE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1191250",
  "drug_name" : "2 ML NALOXONE HYDROCHLORIDE 1 MG\\/ML PREFILLED SYRINGE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1191256",
  "drug_name" : "FLUOCINOLONE ACETONIDE 0.00025 MG\\/MG TOPICAL OINTMENT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1191299",
  "drug_name" : "FLUOCINOLONE ACETONIDE 0.1 MG\\/ML OTIC SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1191302",
  "drug_name" : "FLUOCINOLONE ACETONIDE 0.1 MG\\/ML TOPICAL CREAM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1191307",
  "drug_name" : "FLUOCINOLONE ACETONIDE 0.1 MG\\/ML TOPICAL OIL",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1191310",
  "drug_name" : "FLUOCINOLONE ACETONIDE 0.1 MG\\/ML TOPICAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1191315",
  "drug_name" : "FLUOCINOLONE ACETONIDE 0.25 MG\\/ML TOPICAL CREAM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1191325",
  "drug_name" : "FLUOCINOLONE ACETONIDE 0.59 MG DRUG IMPLANT [RETISERT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1193337",
  "drug_name" : "RUXOLITINIB 10 MG ORAL TABLET [JAKAFI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1193341",
  "drug_name" : "RUXOLITINIB 5 MG ORAL TABLET [JAKAFI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1193345",
  "drug_name" : "RUXOLITINIB 15 MG ORAL TABLET [JAKAFI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1193349",
  "drug_name" : "RUXOLITINIB 20 MG ORAL TABLET [JAKAFI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1193353",
  "drug_name" : "RUXOLITINIB 25 MG ORAL TABLET [JAKAFI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1193358",
  "drug_name" : "100 ML LEVETIRACETAM 10 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1193360",
  "drug_name" : "100 ML LEVETIRACETAM 15 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1193362",
  "drug_name" : "100 ML LEVETIRACETAM 5 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1232084",
  "drug_name" : "RIVAROXABAN 15 MG ORAL TABLET [XARELTO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1232088",
  "drug_name" : "RIVAROXABAN 20 MG ORAL TABLET [XARELTO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1232159",
  "drug_name" : "0.05 ML AFLIBERCEPT 40 MG\\/ML INJECTION [EYLEA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1232585",
  "drug_name" : "24 HR BUPROPION HYDROCHLORIDE 450 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1233711",
  "drug_name" : "ALPHA 1-PROTEINASE INHIBITOR, HUMAN 1 MG INJECTION [ARALAST]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1234571",
  "drug_name" : "PHENYLEPHRINE HYDROCHLORIDE 100 MG\\/ML OPHTHALMIC SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1234579",
  "drug_name" : "PHENYLEPHRINE HYDROCHLORIDE 25 MG\\/ML OPHTHALMIC SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1235049",
  "drug_name" : "HYDROCORTISONE ACETATE 10 MG\\/ML \\/ PRAMOXINE HYDROCHLORIDE 10 MG\\/ML RECTAL CREAM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1235247",
  "drug_name" : "LURASIDONE HYDROCHLORIDE 20 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1235591",
  "drug_name" : "RALTEGRAVIR 100 MG CHEWABLE TABLET [ISENTRESS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1235595",
  "drug_name" : "RALTEGRAVIR 25 MG CHEWABLE TABLET [ISENTRESS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1236632",
  "drug_name" : "DARUNAVIR 100 MG\\/ML ORAL SUSPENSION [PREZISTA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1242136",
  "drug_name" : "GLUCARPIDASE 1000 UNT INJECTION [VORAXAZE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1242231",
  "drug_name" : "LENALIDOMIDE 2.5 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1242233",
  "drug_name" : "LENALIDOMIDE 2.5 MG ORAL CAPSULE [REVLIMID]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1242998",
  "drug_name" : "VISMODEGIB 150 MG ORAL CAPSULE [ERIVEDGE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1243010",
  "drug_name" : "AXITINIB 1 MG ORAL TABLET [INLYTA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1243014",
  "drug_name" : "AXITINIB 5 MG ORAL TABLET [INLYTA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1243052",
  "drug_name" : "IVACAFTOR 150 MG ORAL TABLET [KALYDECO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1243229",
  "drug_name" : "TENOFOVIR DISOPROXIL FUMARATE 250 MG ORAL TABLET [VIREAD]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1243326",
  "drug_name" : "TENOFOVIR DISOPROXIL FUMARATE 150 MG ORAL TABLET [VIREAD]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1243330",
  "drug_name" : "TENOFOVIR DISOPROXIL FUMARATE 200 MG ORAL TABLET [VIREAD]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1243346",
  "drug_name" : "TENOFOVIR DISOPROXIL FUMARATE 0.04 MG\\/MG ORAL POWDER [VIREAD]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1243585",
  "drug_name" : "FLURBIPROFEN SODIUM 0.3 MG\\/ML OPHTHALMIC SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1244062",
  "drug_name" : "0.6 ML METHYLNALTREXONE BROMIDE 20 MG\\/ML PREFILLED SYRINGE [RELISTOR]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1244214",
  "drug_name" : "BUDESONIDE 3 MG DELAYED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1244634",
  "drug_name" : "BETAMETHASONE VALERATE 1.2 MG\\/ML TOPICAL FOAM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1245001",
  "drug_name" : "ELTROMBOPAG 12.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1245262",
  "drug_name" : "MIFEPRISTONE 300 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1245268",
  "drug_name" : "MIFEPRISTONE 300 MG ORAL TABLET [KORLYM]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1247658",
  "drug_name" : "GLYCOPYRROLATE 1.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1250723",
  "drug_name" : "ETRAVIRINE 25 MG ORAL TABLET [INTELENCE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1251903",
  "drug_name" : "ETHACRYNIC ACID 25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1292443",
  "drug_name" : "[PROQUAD]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "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" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1292828",
  "drug_name" : "YELLOW FEVER VIRUS STRAIN 17D-204 LIVE ANTIGEN 4000 UNT\\/ML INJECTABLE SUSPENSION [YF-VAX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1292881",
  "drug_name" : "TALIGLUCERASE ALFA 200 UNT INJECTION [ELELYSO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1292887",
  "drug_name" : "250 ML DOPAMINE HYDROCHLORIDE 3.2 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1293504",
  "drug_name" : "CAFFEINE 100 MG \\/ ERGOTAMINE TARTRATE 1 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1293648",
  "drug_name" : "1.7 ML EPINEPHRINE 0.01 MG\\/ML \\/ LIDOCAINE HYDROCHLORIDE 20 MG\\/ML CARTRIDGE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1293864",
  "drug_name" : "ERGOTAMINE TARTRATE 2 MG SUBLINGUAL TABLET [ERGOMAR]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1294619",
  "drug_name" : "BISMUTH SUBCITRATE 140 MG \\/ METRONIDAZOLE 125 MG \\/ TETRACYCLINE HYDROCHLORIDE 125 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1297278",
  "drug_name" : "LURASIDONE HYDROCHLORIDE 120 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1298816",
  "drug_name" : "MOLINDONE HYDROCHLORIDE 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1298906",
  "drug_name" : "MOLINDONE HYDROCHLORIDE 25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1298910",
  "drug_name" : "MOLINDONE HYDROCHLORIDE 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1298953",
  "drug_name" : "14 ML PERTUZUMAB 30 MG\\/ML INJECTION [PERJETA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1299903",
  "drug_name" : "TIAGABINE HYDROCHLORIDE 12 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1299909",
  "drug_name" : "TIAGABINE HYDROCHLORIDE 16 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1299911",
  "drug_name" : "TIAGABINE HYDROCHLORIDE 2 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1299917",
  "drug_name" : "TIAGABINE HYDROCHLORIDE 4 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1300191",
  "drug_name" : "[ADACEL]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1300206",
  "drug_name" : "[ADACEL]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1300310",
  "drug_name" : "[DAPTACEL]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1300370",
  "drug_name" : "[BOOSTRIX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1300378",
  "drug_name" : "[BOOSTRIX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1300384",
  "drug_name" : "[INFANRIX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1300468",
  "drug_name" : "0.5 ML HAEMOPHILUS INFLUENZAE TYPE B STRAIN 1482, CAPSULAR POLYSACCHARIDE INACTIVATED TETANUS TOXOID CONJUGATE VACCINE 0.068 MG\\/ML INJECTION [ACTHIB]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1300783",
  "drug_name" : "0.5 ML JAPANESE ENCEPHALITIS VIRUS VACCINE NAKAYAMA-NIH STRAIN, INACTIVATED 0.012 MG\\/ML PREFILLED SYRINGE [IXIARO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1300791",
  "drug_name" : "24 HR MIRABEGRON 25 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1300797",
  "drug_name" : "24 HR MIRABEGRON 25 MG EXTENDED RELEASE ORAL TABLET [MYRBETRIQ]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1300801",
  "drug_name" : "24 HR MIRABEGRON 50 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1300803",
  "drug_name" : "24 HR MIRABEGRON 50 MG EXTENDED RELEASE ORAL TABLET [MYRBETRIQ]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1300810",
  "drug_name" : "0.5 ML HAEMOPHILUS INFLUENZAE TYPE B STRAIN 20752, CAPSULAR POLYSACCHARIDE INACTIVATED TETANUS TOXOID CONJUGATE VACCINE 0.07 MG\\/ML INJECTION [HIBERIX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1304979",
  "drug_name" : "ICOSAPENT ETHYL 1000 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1305268",
  "drug_name" : "NDA201739 0.15 ML EPINEPHRINE 1 MG\\/ML AUTO-INJECTOR [AUVI-Q]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1305269",
  "drug_name" : "NDA201739 0.3 ML EPINEPHRINE 1 MG\\/ML AUTO-INJECTOR [AUVI-Q]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1306076",
  "drug_name" : "0.05 ML RANIBIZUMAB 6 MG\\/ML INJECTION [LUCENTIS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "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" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1307309",
  "drug_name" : "ENZALUTAMIDE 40 MG ORAL CAPSULE [XTANDI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1307415",
  "drug_name" : "LINACLOTIDE 0.145 MG ORAL CAPSULE [LINZESS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1307421",
  "drug_name" : "LINACLOTIDE 0.29 MG ORAL CAPSULE [LINZESS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1307427",
  "drug_name" : "SILDENAFIL 10 MG\\/ML ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1307630",
  "drug_name" : "BOSUTINIB 100 MG ORAL TABLET [BOSULIF]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1307635",
  "drug_name" : "BOSUTINIB 500 MG ORAL TABLET [BOSULIF]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1308428",
  "drug_name" : "EVEROLIMUS 2 MG TABLET FOR ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1308430",
  "drug_name" : "EVEROLIMUS 3 MG TABLET FOR ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1308432",
  "drug_name" : "EVEROLIMUS 5 MG TABLET FOR ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1310138",
  "drug_name" : "EVEROLIMUS 2 MG TABLET FOR ORAL SUSPENSION [AFINITOR]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1310144",
  "drug_name" : "EVEROLIMUS 3 MG TABLET FOR ORAL SUSPENSION [AFINITOR]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1310147",
  "drug_name" : "EVEROLIMUS 5 MG TABLET FOR ORAL SUSPENSION [AFINITOR]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1310525",
  "drug_name" : "TERIFLUNOMIDE 14 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1310533",
  "drug_name" : "TERIFLUNOMIDE 7 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1312408",
  "drug_name" : "REGORAFENIB 40 MG ORAL TABLET [STIVARGA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1313112",
  "drug_name" : "PHENYTOIN 25 MG\\/ML ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1313785",
  "drug_name" : "CYSTEAMINE 4.4 MG\\/ML OPHTHALMIC SOLUTION [CYSTARAN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1313885",
  "drug_name" : "PHENYTOIN 50 MG CHEWABLE TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1313887",
  "drug_name" : "PHENYTOIN 50 MG CHEWABLE TABLET [DILANTIN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1314133",
  "drug_name" : "2 ML ONDANSETRON 2 MG\\/ML PREFILLED SYRINGE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1314763",
  "drug_name" : "TOBRAMYCIN 75 MG\\/ML INHALATION SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1356557",
  "drug_name" : "PERAMPANEL 2 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1356570",
  "drug_name" : "PERAMPANEL 4 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1356574",
  "drug_name" : "PERAMPANEL 6 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1356578",
  "drug_name" : "PERAMPANEL 8 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1356582",
  "drug_name" : "PERAMPANEL 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1356586",
  "drug_name" : "PERAMPANEL 12 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1356693",
  "drug_name" : "OMACETAXINE MEPESUCCINATE 3.5 MG INJECTION [SYNRIBO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1357547",
  "drug_name" : "TOFACITINIB 5 MG ORAL TABLET [XELJANZ]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1357888",
  "drug_name" : "METHYLPREDNISOLONE 2000 MG INJECTION [SOLU-MEDROL]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1358512",
  "drug_name" : "METHYLPREDNISOLONE ACETATE 20 MG\\/ML INJECTABLE SUSPENSION [DEPO-MEDROL]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1358610",
  "drug_name" : "METHYLPREDNISOLONE ACETATE 40 MG\\/ML INJECTABLE SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1358617",
  "drug_name" : "METHYLPREDNISOLONE ACETATE 80 MG\\/ML INJECTABLE SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1358765",
  "drug_name" : "JUNEL FE 1\\/20 28 DAY PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1358775",
  "drug_name" : "MICROGESTIN FE 1\\/20 28 DAY PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1358780",
  "drug_name" : "JUNEL 1\\/20 21 DAY PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1358781",
  "drug_name" : "LOESTRIN 1\\/20 21 DAY PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1359020",
  "drug_name" : "MICROGESTIN 1\\/20 21 DAY PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1359025",
  "drug_name" : "JUNEL FE 28 DAY PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1359027",
  "drug_name" : "MICROGESTIN FE 1.5\\/30 28 DAY PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1359030",
  "drug_name" : "JUNEL 1.5\\/30 21 DAY PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1359269",
  "drug_name" : "DARUNAVIR 800 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1361226",
  "drug_name" : "HEPARIN SODIUM, PORCINE 1000 UNT\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1361574",
  "drug_name" : "HEPARIN SODIUM, PORCINE 20000 UNT\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1361607",
  "drug_name" : "500 ML HEPARIN SODIUM, PORCINE 40 UNT\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1361615",
  "drug_name" : "HEPARIN SODIUM, PORCINE 5000 UNT\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1361853",
  "drug_name" : "0.5 ML HEPARIN SODIUM, PORCINE 10000 UNT\\/ML CARTRIDGE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1362706",
  "drug_name" : "MEXILETINE HYDROCHLORIDE 150 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1362712",
  "drug_name" : "MEXILETINE HYDROCHLORIDE 200 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1362720",
  "drug_name" : "MEXILETINE HYDROCHLORIDE 250 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1363408",
  "drug_name" : "COMETRIQ 140 MG DAILY DOSE CARTON PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1363410",
  "drug_name" : "COMETRIQ 100 MG DAILY DOSE CARTON PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1364114",
  "drug_name" : "1 ML PASIREOTIDE 0.3 MG\\/ML INJECTION [SIGNIFOR]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1364118",
  "drug_name" : "1 ML PASIREOTIDE 0.6 MG\\/ML INJECTION [SIGNIFOR]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1364122",
  "drug_name" : "1 ML PASIREOTIDE 0.9 MG\\/ML INJECTION [SIGNIFOR]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1364358",
  "drug_name" : "PONATINIB 15 MG ORAL TABLET [ICLUSIG]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1364362",
  "drug_name" : "PONATINIB 45 MG ORAL TABLET [ICLUSIG]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1364447",
  "drug_name" : "APIXABAN 5 MG ORAL TABLET [ELIQUIS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1364477",
  "drug_name" : "TEDUGLUTIDE 5 MG INJECTION [GATTEX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1364515",
  "drug_name" : "BEDAQUILINE 100 MG ORAL TABLET [SIRTURO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1364581",
  "drug_name" : "COMETRIQ 60 MG DAILY DOSE CARTON PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1366192",
  "drug_name" : "CLOBAZAM 2.5 MG\\/ML ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1366550",
  "drug_name" : "24 HR BUDESONIDE 9 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1367436",
  "drug_name" : "21 DAY ETHINYL ESTRADIOL 0.000625 MG\\/HR \\/ ETONOGESTREL 0.005 MG\\/HR VAGINAL SYSTEM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1368459",
  "drug_name" : "GLYCEROL PHENYLBUTYRATE 1100 MG\\/ML ORAL SOLUTION [RAVICTI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1369724",
  "drug_name" : "POMALIDOMIDE 1 MG ORAL CAPSULE [POMALYST]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1369728",
  "drug_name" : "POMALIDOMIDE 2 MG ORAL CAPSULE [POMALYST]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1369732",
  "drug_name" : "POMALIDOMIDE 3 MG ORAL CAPSULE [POMALYST]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1369736",
  "drug_name" : "POMALIDOMIDE 4 MG ORAL CAPSULE [POMALYST]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1369831",
  "drug_name" : "CLOZAPINE 50 MG\\/ML ORAL SUSPENSION [VERSACLOZ]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1370750",
  "drug_name" : "HYDROCORTISONE VALERATE 0.002 MG\\/MG TOPICAL OINTMENT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1370754",
  "drug_name" : "HYDROCORTISONE VALERATE 2 MG\\/ML TOPICAL CREAM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1370758",
  "drug_name" : "HYDROCORTISONE BUTYRATE 0.001 MG\\/MG TOPICAL OINTMENT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1370767",
  "drug_name" : "HYDROCORTISONE BUTYRATE 1 MG\\/ML TOPICAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1370770",
  "drug_name" : "HYDROCORTISONE BUTYRATE 1 MG\\/ML TOPICAL CREAM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1373327",
  "drug_name" : "AMYLASE 180000 UNT \\/ LIPASE 36000 UNT \\/ PROTEASE 114000 UNT DELAYED RELEASE ORAL CAPSULE [CREON]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1373483",
  "drug_name" : "DIMETHYL FUMARATE 120 MG DELAYED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1373491",
  "drug_name" : "DIMETHYL FUMARATE 240 MG DELAYED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "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" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1373745",
  "drug_name" : "24 HR NEVIRAPINE 100 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1374574",
  "drug_name" : "TOBI PODHALER KIT, 224",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1376336",
  "drug_name" : "PREDNISOLONE ACETATE 10 MG\\/ML OPHTHALMIC SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "141935",
  "drug_name" : "HALOPERIDOL 2 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "141963",
  "drug_name" : "AZITHROMYCIN 40 MG\\/ML ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "142046",
  "drug_name" : "METRONIDAZOLE 0.0075 MG\\/MG VAGINAL GEL",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "142113",
  "drug_name" : "MESNA 400 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1421473",
  "drug_name" : "CYSTEAMINE 25 MG DELAYED RELEASE ORAL CAPSULE [PROCYSBI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1421477",
  "drug_name" : "CYSTEAMINE 75 MG DELAYED RELEASE ORAL CAPSULE [PROCYSBI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1423767",
  "drug_name" : "NIMODIPINE 3 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1425110",
  "drug_name" : "TRAMETINIB 0.5 MG ORAL TABLET [MEKINIST]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1425118",
  "drug_name" : "TRAMETINIB 2 MG ORAL TABLET [MEKINIST]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1425228",
  "drug_name" : "DABRAFENIB 50 MG ORAL CAPSULE [TAFINLAR]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1425230",
  "drug_name" : "DABRAFENIB 75 MG ORAL CAPSULE [TAFINLAR]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "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" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1428947",
  "drug_name" : "LENALIDOMIDE 20 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1429367",
  "drug_name" : "LENALIDOMIDE 20 MG ORAL CAPSULE [REVLIMID]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1430122",
  "drug_name" : "PAROXETINE MESYLATE 7.5 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1430449",
  "drug_name" : "AFATINIB 20 MG ORAL TABLET [GILOTRIF]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1430453",
  "drug_name" : "AFATINIB 30 MG ORAL TABLET [GILOTRIF]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1430457",
  "drug_name" : "AFATINIB 40 MG ORAL TABLET [GILOTRIF]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1431235",
  "drug_name" : "LURASIDONE HYDROCHLORIDE 60 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1431647",
  "drug_name" : "4 ML GOLIMUMAB 12.5 MG\\/ML INJECTION [SIMPONI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1432969",
  "drug_name" : "168 HR BUPRENORPHINE 0.015 MG\\/HR TRANSDERMAL SYSTEM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1433223",
  "drug_name" : "24 HR LEVOMILNACIPRAN 120 MG EXTENDED RELEASE ORAL CAPSULE [FETZIMA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1433229",
  "drug_name" : "24 HR LEVOMILNACIPRAN 20 MG EXTENDED RELEASE ORAL CAPSULE [FETZIMA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1433235",
  "drug_name" : "24 HR LEVOMILNACIPRAN 40 MG EXTENDED RELEASE ORAL CAPSULE [FETZIMA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1433241",
  "drug_name" : "24 HR LEVOMILNACIPRAN 80 MG EXTENDED RELEASE ORAL CAPSULE [FETZIMA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1433250",
  "drug_name" : "FETZIMA TITRATION PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1433879",
  "drug_name" : "DOLUTEGRAVIR 50 MG ORAL TABLET [TIVICAY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1435115",
  "drug_name" : "28 ACTUAT TERIPARATIDE 0.02 MG\\/ACTUAT PEN INJECTOR",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1435117",
  "drug_name" : "28 ACTUAT TERIPARATIDE 0.02 MG\\/ACTUAT PEN INJECTOR [FORTEO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1437702",
  "drug_name" : "ALBUTEROL 0.833 MG\\/ML \\/ IPRATROPIUM BROMIDE 0.167 MG\\/ML INHALATION SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1437713",
  "drug_name" : "MECHLORETHAMINE 0.00016 MG\\/MG TOPICAL GEL [VALCHLOR]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1437968",
  "drug_name" : "CYCLOPHOSPHAMIDE 25 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1437969",
  "drug_name" : "CYCLOPHOSPHAMIDE 50 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1439894",
  "drug_name" : "RIOCIGUAT 0.5 MG ORAL TABLET [ADEMPAS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1439896",
  "drug_name" : "RIOCIGUAT 1 MG ORAL TABLET [ADEMPAS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1439899",
  "drug_name" : "RIOCIGUAT 1.5 MG ORAL TABLET [ADEMPAS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1439901",
  "drug_name" : "RIOCIGUAT 2 MG ORAL TABLET [ADEMPAS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1439903",
  "drug_name" : "RIOCIGUAT 2.5 MG ORAL TABLET [ADEMPAS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1440936",
  "drug_name" : "HYDROCORTISONE 25 MG\\/ML TOPICAL CREAM [PROCTOZONE HC]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1441530",
  "drug_name" : "0.9 ML TOCILIZUMAB 180 MG\\/ML PREFILLED SYRINGE [ACTEMRA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1442445",
  "drug_name" : "ACETAMINOPHEN 20 MG\\/ML \\/ HYDROCODONE BITARTRATE 0.667 MG\\/ML ORAL SOLUTION [LORTAB]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1442681",
  "drug_name" : "0.5 ML TBO-FILGRASTIM 0.6 MG\\/ML PREFILLED SYRINGE [GRANIX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1442683",
  "drug_name" : "0.8 ML TBO-FILGRASTIM 0.6 MG\\/ML PREFILLED SYRINGE [GRANIX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1442698",
  "drug_name" : "40 ML OBINUTUZUMAB 25 MG\\/ML INJECTION [GAZYVA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1442992",
  "drug_name" : "IBRUTINIB 140 MG ORAL CAPSULE [IMBRUVICA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1482507",
  "drug_name" : "ESLICARBAZEPINE ACETATE 200 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1482515",
  "drug_name" : "ESLICARBAZEPINE ACETATE 400 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1482521",
  "drug_name" : "ESLICARBAZEPINE ACETATE 600 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1482525",
  "drug_name" : "ESLICARBAZEPINE ACETATE 800 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1482814",
  "drug_name" : "1 ML GOLIMUMAB 100 MG\\/ML PREFILLED SYRINGE [SIMPONI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1482908",
  "drug_name" : "POSACONAZOLE 100 MG DELAYED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1483744",
  "drug_name" : "NALTREXONE HYDROCHLORIDE 50 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1484296",
  "drug_name" : "SUCROFERRIC OXYHYDROXIDE 500 MG CHEWABLE TABLET [VELPHORO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1484922",
  "drug_name" : "SOFOSBUVIR 400 MG ORAL TABLET [SOVALDI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1486496",
  "drug_name" : "0.5 ML TYPHOID VI POLYSACCHARIDE VACCINE, S TYPHI TY2 STRAIN 0.05 MG\\/ML PREFILLED SYRINGE [TYPHIM VI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1486687",
  "drug_name" : "SAPROPTERIN DIHYDROCHLORIDE 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1486841",
  "drug_name" : "RALTEGRAVIR 100 MG GRANULES FOR ORAL SUSPENSION [ISENTRESS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1488671",
  "drug_name" : "12 HR TREPROSTINIL 0.25 MG EXTENDED RELEASE ORAL TABLET [ORENITRAM]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1488675",
  "drug_name" : "12 HR TREPROSTINIL 1 MG EXTENDED RELEASE ORAL TABLET [ORENITRAM]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1488679",
  "drug_name" : "12 HR TREPROSTINIL 2.5 MG EXTENDED RELEASE ORAL TABLET [ORENITRAM]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1490026",
  "drug_name" : "DROXIDOPA 100 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1490034",
  "drug_name" : "DROXIDOPA 200 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1490038",
  "drug_name" : "DROXIDOPA 300 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1490052",
  "drug_name" : "5 ML ELOSULFASE ALFA 1 MG\\/ML INJECTION [VIMIZIM]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1490065",
  "drug_name" : "RALOXIFENE HYDROCHLORIDE 60 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1490473",
  "drug_name" : "TASIMELTEON 20 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1492742",
  "drug_name" : "APREMILAST 20 MG ORAL TABLET [OTEZLA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1492746",
  "drug_name" : "APREMILAST 30 MG ORAL TABLET [OTEZLA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1494769",
  "drug_name" : "SPRINKLE 24 HR TOPIRAMATE 150 MG EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1495070",
  "drug_name" : "MILTEFOSINE 50 MG ORAL CAPSULE [IMPAVIDO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1495316",
  "drug_name" : "TIMOTHY GRASS POLLEN EXTRACT 2800 BAU SUBLINGUAL TABLET [GRASTEK]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "150985",
  "drug_name" : "WATER 1000 MG\\/ML IRRIGATION SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "151029",
  "drug_name" : "MOMETASONE FUROATE 0.001 MG\\/MG TOPICAL OINTMENT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "151030",
  "drug_name" : "MOMETASONE FUROATE 1 MG\\/ML TOPICAL LOTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "151226",
  "drug_name" : "TOPIRAMATE 50 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "152695",
  "drug_name" : "MELOXICAM 15 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "152970",
  "drug_name" : "RITONAVIR 100 MG ORAL CAPSULE [NORVIR]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "152971",
  "drug_name" : "RITONAVIR 80 MG\\/ML ORAL SOLUTION [NORVIR]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "153098",
  "drug_name" : "DEFLAZACORT 6 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1536144",
  "drug_name" : "120 ACTUAT MOMETASONE FUROATE 0.1 MG\\/ACTUAT METERED DOSE INHALER [ASMANEX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1536148",
  "drug_name" : "120 ACTUAT MOMETASONE FUROATE 0.2 MG\\/ACTUAT METERED DOSE INHALER [ASMANEX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1536484",
  "drug_name" : "MERCAPTOPURINE 20 MG\\/ML ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1536586",
  "drug_name" : "168 HR ETHINYL ESTRADIOL 0.00146 MG\\/HR \\/ NORELGESTROMIN 0.00625 MG\\/HR TRANSDERMAL SYSTEM [XULANE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1538142",
  "drug_name" : "VEDOLIZUMAB 300 MG INJECTION [ENTYVIO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "153822",
  "drug_name" : "CANDESARTAN CILEXETIL 4 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "153823",
  "drug_name" : "CANDESARTAN CILEXETIL 8 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "153880",
  "drug_name" : "DEFLAZACORT 30 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1539248",
  "drug_name" : "DALBAVANCIN 500 MG INJECTION [DALVANCE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1540241",
  "drug_name" : "BENZOYL PEROXIDE 0.05 MG\\/MG \\/ CLINDAMYCIN PHOSPHATE 0.012 MG\\/MG TOPICAL GEL",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1540868",
  "drug_name" : "TEDIZOLID PHOSPHATE 200 MG ORAL TABLET [SIVEXTRO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1541890",
  "drug_name" : "SUNITINIB 37.5 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1541928",
  "drug_name" : "SUNITINIB 37.5 MG ORAL CAPSULE [SUTENT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1542997",
  "drug_name" : "168 HR BUPRENORPHINE 0.0075 MG\\/HR TRANSDERMAL SYSTEM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1543069",
  "drug_name" : "LIDOCAINE 0.05 MG\\/MG TOPICAL OINTMENT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1543552",
  "drug_name" : "BELINOSTAT 500 MG INJECTION [BELEODAQ]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1543553",
  "drug_name" : "NIKKI 28 DAY PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1544383",
  "drug_name" : "0.2 ML METHOTREXATE 50 MG\\/ML AUTO-INJECTOR [RASUVO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1544386",
  "drug_name" : "0.25 ML METHOTREXATE 50 MG\\/ML AUTO-INJECTOR [RASUVO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1544388",
  "drug_name" : "0.3 ML METHOTREXATE 50 MG\\/ML AUTO-INJECTOR [RASUVO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1544390",
  "drug_name" : "0.35 ML METHOTREXATE 50 MG\\/ML AUTO-INJECTOR [RASUVO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1544394",
  "drug_name" : "0.4 ML METHOTREXATE 50 MG\\/ML AUTO-INJECTOR [RASUVO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1544396",
  "drug_name" : "0.45 ML METHOTREXATE 50 MG\\/ML AUTO-INJECTOR [RASUVO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1544398",
  "drug_name" : "0.5 ML METHOTREXATE 50 MG\\/ML AUTO-INJECTOR [RASUVO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1544402",
  "drug_name" : "0.6 ML METHOTREXATE 50 MG\\/ML AUTO-INJECTOR [RASUVO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1544404",
  "drug_name" : "0.15 ML METHOTREXATE 50 MG\\/ML AUTO-INJECTOR [RASUVO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1544471",
  "drug_name" : "IDELALISIB 100 MG ORAL TABLET [ZYDELIG]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1544475",
  "drug_name" : "IDELALISIB 150 MG ORAL TABLET [ZYDELIG]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1545664",
  "drug_name" : "EMPAGLIFLOZIN 10 MG ORAL TABLET [JARDIANCE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1545668",
  "drug_name" : "EMPAGLIFLOZIN 25 MG ORAL TABLET [JARDIANCE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1545776",
  "drug_name" : "LOMUSTINE 10 MG ORAL CAPSULE [GLEOSTINE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1545778",
  "drug_name" : "LOMUSTINE 100 MG ORAL CAPSULE [GLEOSTINE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1545780",
  "drug_name" : "LOMUSTINE 40 MG ORAL CAPSULE [GLEOSTINE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1546083",
  "drug_name" : "60 ACTUAT OLODATEROL 0.0025 MG\\/ACTUAT INHALATION SPRAY [STRIVERDI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1546189",
  "drug_name" : "0.5 ML PEGINTERFERON BETA-1A 0.25 MG\\/ML PREFILLED SYRINGE [PLEGRIDY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1546198",
  "drug_name" : "PLEGRIDY STARTER PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1546894",
  "drug_name" : "ABACAVIR 600 MG \\/ DOLUTEGRAVIR 50 MG \\/ LAMIVUDINE 300 MG ORAL TABLET [TRIUMEQ]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1547231",
  "drug_name" : "ELIGLUSTAT 84 MG ORAL CAPSULE [CERDELGA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1547620",
  "drug_name" : "ORITAVANCIN 400 MG INJECTION [ORBACTIV]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1547771",
  "drug_name" : "TETRACAINE HYDROCHLORIDE 5 MG\\/ML OPHTHALMIC SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1549447",
  "drug_name" : "LIDOCAINE HYDROCHLORIDE 0.02 MG\\/MG TOPICAL GEL [GLYDO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1549454",
  "drug_name" : "PEGVISOMANT 30 MG INJECTION [SOMAVERT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1549456",
  "drug_name" : "PEGVISOMANT 25 MG INJECTION [SOMAVERT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1549683",
  "drug_name" : "XARELTO 30-DAY STARTER PACK KIT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1549688",
  "drug_name" : "HYQVIA 2400 UNT PER 15 ML \\/ 30 G PER 300 ML (10 % ) KIT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1549690",
  "drug_name" : "HYQVIA 200 UNT PER 1.25 ML \\/ 2.5 G PER 25 ML (10 % ) KIT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1549692",
  "drug_name" : "HYQVIA 400 UNT PER 2.5 ML \\/ 5 G PER 50 ML (10 % ) KIT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1549694",
  "drug_name" : "HYQVIA 800 UNT PER 5 ML \\/ 10 G PER 100 ML (10 % ) KIT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1549696",
  "drug_name" : "HYQVIA 1600 UNT PER 10 ML \\/ 20 G PER 200 ML (10 % ) KIT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1551395",
  "drug_name" : "1 ML MIDAZOLAM 5 MG\\/ML PREFILLED SYRINGE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1551999",
  "drug_name" : "COBICISTAT 150 MG ORAL TABLET [TYBOST]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1552004",
  "drug_name" : "60 ACTUAT TIOTROPIUM 0.0025 MG\\/ACTUAT INHALATION SPRAY [SPIRIVA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1552356",
  "drug_name" : "FLUOCINOLONE ACETONIDE 0.19 MG DRUG IMPLANT [ILUVIEN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1591943",
  "drug_name" : "LEDIPASVIR 90 MG \\/ SOFOSBUVIR 400 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1591949",
  "drug_name" : "LEDIPASVIR 90 MG \\/ SOFOSBUVIR 400 MG ORAL TABLET [HARVONI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1592279",
  "drug_name" : "PIRFENIDONE 267 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1592748",
  "drug_name" : "NINTEDANIB 100 MG ORAL CAPSULE [OFEV]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1592752",
  "drug_name" : "NINTEDANIB 150 MG ORAL CAPSULE [OFEV]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1593140",
  "drug_name" : "0.5 ML NEISSERIA MENINGITIDIS SEROGROUP B RECOMBINANT LP2086 A05 PROTEIN VARIANT ANTIGEN 0.12 MG\\/ML \\/ NEISSERIA MENINGITIDIS SEROGROUP B RECOMBINANT LP2086 B01 PROTEIN VARIANT ANTIGEN 0.12 MG\\/ML PREFILLED SYRINGE [TRUMENBA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1593856",
  "drug_name" : "LISDEXAMFETAMINE DIMESYLATE 10 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1594589",
  "drug_name" : "SUCCINYLCHOLINE CHLORIDE 20 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1594663",
  "drug_name" : "1.2 ML ALEMTUZUMAB 10 MG\\/ML INJECTION [LEMTRADA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1594673",
  "drug_name" : "AMYLASE 105000 UNT \\/ LIPASE 25000 UNT \\/ PROTEASE 79000 UNT DELAYED RELEASE ORAL CAPSULE [ZENPEP]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1595292",
  "drug_name" : "AMYLASE 14000 UNT \\/ LIPASE 3000 UNT \\/ PROTEASE 10000 UNT DELAYED RELEASE ORAL CAPSULE [ZENPEP]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1595457",
  "drug_name" : "AMYLASE 24000 UNT \\/ LIPASE 5000 UNT \\/ PROTEASE 17000 UNT DELAYED RELEASE ORAL CAPSULE [ZENPEP]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1595462",
  "drug_name" : "AMYLASE 42000 UNT \\/ LIPASE 10000 UNT \\/ PROTEASE 32000 UNT DELAYED RELEASE ORAL CAPSULE [ZENPEP]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1595473",
  "drug_name" : "AMYLASE 63000 UNT \\/ LIPASE 15000 UNT \\/ PROTEASE 47000 UNT DELAYED RELEASE ORAL CAPSULE [ZENPEP]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1595478",
  "drug_name" : "AMYLASE 84000 UNT \\/ LIPASE 20000 UNT \\/ PROTEASE 63000 UNT DELAYED RELEASE ORAL CAPSULE [ZENPEP]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1596023",
  "drug_name" : "FERRIC CITRATE 1000 MG ORAL TABLET [AURYXIA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1596030",
  "drug_name" : "TOBRAMYCIN 60 MG\\/ML INHALATION SOLUTION [KITABIS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1596780",
  "drug_name" : "60 ACTUAT TESTOSTERONE 12.5 MG\\/ACTUAT TOPICAL GEL",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1597076",
  "drug_name" : "60 ACTUAT TESTOSTERONE 20.25 MG\\/ACTUAT TOPICAL GEL",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1597099",
  "drug_name" : "[GARDASIL 9]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1597103",
  "drug_name" : "[GARDASIL 9]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1597123",
  "drug_name" : "2500 MG TESTOSTERONE 0.01 MG\\/MG TOPICAL GEL",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1597129",
  "drug_name" : "5000 MG TESTOSTERONE 0.01 MG\\/MG TOPICAL GEL",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1597267",
  "drug_name" : "BLINATUMOMAB 0.035 MG INJECTION [BLINCYTO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1597599",
  "drug_name" : "PASIREOTIDE 20 MG INJECTION [SIGNIFOR]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1597603",
  "drug_name" : "PASIREOTIDE 40 MG INJECTION [SIGNIFOR]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1597620",
  "drug_name" : "CEFTOLOZANE 1000 MG \\/ TAZOBACTAM 500 MG INJECTION [ZERBAXA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1597822",
  "drug_name" : "PASIREOTIDE 60 MG INJECTION [SIGNIFOR]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1598989",
  "drug_name" : "ATAZANAVIR 50 MG ORAL POWDER [REYATAZ]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1599797",
  "drug_name" : "1 ML SECUKINUMAB 150 MG\\/ML PREFILLED SYRINGE [COSENTYX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1600710",
  "drug_name" : "COBICISTAT 150 MG \\/ DARUNAVIR 800 MG ORAL TABLET [PREZCOBIX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1601373",
  "drug_name" : "NALOXEGOL 25 MG ORAL TABLET [MOVANTIK]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1601386",
  "drug_name" : "PALBOCICLIB 100 MG ORAL CAPSULE [IBRANCE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1601390",
  "drug_name" : "PALBOCICLIB 125 MG ORAL CAPSULE [IBRANCE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1601394",
  "drug_name" : "PALBOCICLIB 75 MG ORAL CAPSULE [IBRANCE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1601407",
  "drug_name" : "[BEXSERO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1601660",
  "drug_name" : "ATAZANAVIR 300 MG \\/ COBICISTAT 150 MG ORAL TABLET [EVOTAZ]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1601982",
  "drug_name" : "[PLENAMINE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1602604",
  "drug_name" : "1.5 ML ARIPIPRAZOLE 200 MG\\/ML PREFILLED SYRINGE [ABILIFY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1602607",
  "drug_name" : "2 ML ARIPIPRAZOLE 200 MG\\/ML PREFILLED SYRINGE [ABILIFY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1604350",
  "drug_name" : "LENVIMA 14 MG DAILY DOSE 30 DAY SUPPLY PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1604352",
  "drug_name" : "LENVIMA 24 MG DAILY DOSE 30 DAY SUPPLY PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1604384",
  "drug_name" : "LENVIMA 10 MG DAILY DOSE 30 DAY SUPPLY PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1604395",
  "drug_name" : "LENVIMA 20 MG DAILY DOSE 30 DAY SUPPLY PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1605071",
  "drug_name" : "0.5 ML FILGRASTIM-SNDZ 0.6 MG\\/ML PREFILLED SYRINGE [ZARXIO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1605075",
  "drug_name" : "0.8 ML FILGRASTIM-SNDZ 0.6 MG\\/ML PREFILLED SYRINGE [ZARXIO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1605368",
  "drug_name" : "24 HR LEVETIRACETAM 1000 MG EXTENDED RELEASE ORAL TABLET [ELEPSIA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1605374",
  "drug_name" : "24 HR LEVETIRACETAM 1500 MG EXTENDED RELEASE ORAL TABLET [ELEPSIA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1605455",
  "drug_name" : "OTEZLA 28-DAY 10\\/20\\/30 STARTER PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1606283",
  "drug_name" : "5 ML DINUTUXIMAB 3.5 MG\\/ML INJECTION [UNITUXIN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1606337",
  "drug_name" : "ASENAPINE 2.5 MG SUBLINGUAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1606866",
  "drug_name" : "IVACAFTOR 50 MG ORAL GRANULES [KALYDECO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1606870",
  "drug_name" : "IVACAFTOR 75 MG ORAL GRANULES [KALYDECO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1607617",
  "drug_name" : "24 HR DESVENLAFAXINE SUCCINATE 25 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1607784",
  "drug_name" : "DEFERASIROX 180 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1607792",
  "drug_name" : "DEFERASIROX 360 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1607796",
  "drug_name" : "DEFERASIROX 90 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1607808",
  "drug_name" : "[QUADRACEL]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1608274",
  "drug_name" : "CHOLIC ACID 250 MG ORAL CAPSULE [CHOLBAM]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1608276",
  "drug_name" : "CHOLIC ACID 50 MG ORAL CAPSULE [CHOLBAM]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1608333",
  "drug_name" : "ISAVUCONAZONIUM SULFATE 186 MG ORAL CAPSULE [CRESEMBA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1608815",
  "drug_name" : "ISAVUCONAZONIUM SULFATE 372 MG INJECTION [CRESEMBA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1648183",
  "drug_name" : "40\\/60 RELEASE 24 HR METHYLPHENIDATE HYDROCHLORIDE 15 MG EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1648755",
  "drug_name" : "NITROFURANTOIN, MACROCRYSTALS 25 MG \\/ NITROFURANTOIN, MONOHYDRATE 75 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1648759",
  "drug_name" : "NITROFURANTOIN, MACROCRYSTALS 100 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1649401",
  "drug_name" : "DOXYCYCLINE MONOHYDRATE 50 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1649405",
  "drug_name" : "DOXYCYCLINE HYCLATE 50 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1649485",
  "drug_name" : "IVABRADINE 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1649493",
  "drug_name" : "IVABRADINE 7.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1649593",
  "drug_name" : "0.5 ML PEGINTERFERON BETA-1A 0.25 MG\\/ML AUTO-INJECTOR [PLEGRIDY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1649605",
  "drug_name" : "PLEGRIDY PEN STARTER PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1649988",
  "drug_name" : "DOXYCYCLINE HYCLATE 100 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1649996",
  "drug_name" : "0.5 ML INTERFERON BETA-1A 0.044 MG\\/ML AUTO-INJECTOR [REBIF]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1650004",
  "drug_name" : "0.5 ML INTERFERON BETA-1A 0.088 MG\\/ML AUTO-INJECTOR [REBIF]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1650030",
  "drug_name" : "DOXYCYCLINE MONOHYDRATE 5 MG\\/ML ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1650142",
  "drug_name" : "DOXYCYCLINE MONOHYDRATE 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1650143",
  "drug_name" : "DOXYCYCLINE HYCLATE 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1650282",
  "drug_name" : "REBIF REBIDOSE TITRATION PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1650901",
  "drug_name" : "0.5 ML INTERFERON BETA-1A 0.06 MG\\/ML AUTO-INJECTOR [AVONEX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1650968",
  "drug_name" : "0.88 ML PALIPERIDONE PALMITATE 310 MG\\/ML PREFILLED SYRINGE [INVEGA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1650972",
  "drug_name" : "1.32 ML PALIPERIDONE PALMITATE 311 MG\\/ML PREFILLED SYRINGE [INVEGA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1650974",
  "drug_name" : "1.75 ML PALIPERIDONE PALMITATE 312 MG\\/ML PREFILLED SYRINGE [INVEGA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1650976",
  "drug_name" : "2.63 ML PALIPERIDONE PALMITATE 311 MG\\/ML PREFILLED SYRINGE [INVEGA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1651275",
  "drug_name" : "60 ACTUAT OLODATEROL 0.0025 MG\\/ACTUAT \\/ TIOTROPIUM 0.0025 MG\\/ACTUAT INHALATION SPRAY [STIOLTO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1652084",
  "drug_name" : "JUNEL FE 24 (28 DAY) PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1652639",
  "drug_name" : "3 ML INSULIN LISPRO 100 UNT\\/ML PEN INJECTOR",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1652640",
  "drug_name" : "3 ML INSULIN LISPRO 100 UNT\\/ML PEN INJECTOR [HUMALOG]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1652646",
  "drug_name" : "3 ML INSULIN LISPRO 100 UNT\\/ML CARTRIDGE [HUMALOG]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1652673",
  "drug_name" : "DOXYCYCLINE MONOHYDRATE 50 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1653144",
  "drug_name" : "0.5 ML GOLIMUMAB 100 MG\\/ML AUTO-INJECTOR [SIMPONI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1653166",
  "drug_name" : "1 ML GOLIMUMAB 100 MG\\/ML AUTO-INJECTOR [SIMPONI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1653217",
  "drug_name" : "SAPROPTERIN DIHYDROCHLORIDE 500 MG POWDER FOR ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1653225",
  "drug_name" : "1 ML ETANERCEPT 50 MG\\/ML AUTO-INJECTOR [ENBREL]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1653243",
  "drug_name" : "1 ML SECUKINUMAB 150 MG\\/ML AUTO-INJECTOR [COSENTYX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1653470",
  "drug_name" : "VIIBRYD STARTER PACK 10\\/20 30 DAY PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1653579",
  "drug_name" : "BCG, LIVE, TICE STRAIN 50 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1653792",
  "drug_name" : "ELUXADOLINE 75 MG ORAL TABLET [VIBERZI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1654079",
  "drug_name" : "0.5 ML USTEKINUMAB 90 MG\\/ML INJECTION [STELARA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1654169",
  "drug_name" : "2 ML ADENOSINE 3 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1654630",
  "drug_name" : "1 ML GLATIRAMER ACETATE 20 MG\\/ML PREFILLED SYRINGE [GLATOPA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1654955",
  "drug_name" : "1 ML DARBEPOETIN ALFA 0.2 MG\\/ML INJECTION [ARANESP]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1655728",
  "drug_name" : "0.8 ML ADALIMUMAB 50 MG\\/ML AUTO-INJECTOR [HUMIRA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1655934",
  "drug_name" : "IVACAFTOR 125 MG \\/ LUMACAFTOR 200 MG ORAL TABLET [ORKAMBI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1655956",
  "drug_name" : "40 ML METHOTREXATE 25 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1655959",
  "drug_name" : "10 ML METHOTREXATE 25 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1655960",
  "drug_name" : "2 ML METHOTREXATE 25 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1656313",
  "drug_name" : "CEFOTAXIME 1000 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1656340",
  "drug_name" : "SACUBITRIL 24 MG \\/ VALSARTAN 26 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1656349",
  "drug_name" : "SACUBITRIL 49 MG \\/ VALSARTAN 51 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1656354",
  "drug_name" : "SACUBITRIL 97 MG \\/ VALSARTAN 103 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1656398",
  "drug_name" : "BELIMUMAB 120 MG INJECTION [BENLYSTA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1656402",
  "drug_name" : "BELIMUMAB 400 MG INJECTION [BENLYSTA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1657007",
  "drug_name" : "40 ML IPILIMUMAB 5 MG\\/ML INJECTION [YERVOY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1657013",
  "drug_name" : "10 ML IPILIMUMAB 5 MG\\/ML INJECTION [YERVOY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1657068",
  "drug_name" : "4 ML BEVACIZUMAB 25 MG\\/ML INJECTION [AVASTIN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1657074",
  "drug_name" : "16 ML BEVACIZUMAB 25 MG\\/ML INJECTION [AVASTIN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1657151",
  "drug_name" : "0.5 ML SUMATRIPTAN 12 MG\\/ML AUTO-INJECTOR",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1657160",
  "drug_name" : "0.5 ML SUMATRIPTAN 12 MG\\/ML CARTRIDGE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1657192",
  "drug_name" : "4 ML NIVOLUMAB 10 MG\\/ML INJECTION [OPDIVO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1657196",
  "drug_name" : "10 ML NIVOLUMAB 10 MG\\/ML INJECTION [OPDIVO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1657212",
  "drug_name" : "OMALIZUMAB 150 MG INJECTION [XOLAIR]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1657343",
  "drug_name" : "1 ML PALIVIZUMAB 100 MG\\/ML INJECTION [SYNAGIS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1657362",
  "drug_name" : "0.5 ML PALIVIZUMAB 100 MG\\/ML INJECTION [SYNAGIS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1657660",
  "drug_name" : "50 ML CETUXIMAB 2 MG\\/ML INJECTION [ERBITUX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1657664",
  "drug_name" : "100 ML CETUXIMAB 2 MG\\/ML INJECTION [ERBITUX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1657751",
  "drug_name" : "4 ML PEMBROLIZUMAB 25 MG\\/ML INJECTION [KEYTRUDA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1657777",
  "drug_name" : "10 ML RAMUCIRUMAB 10 MG\\/ML INJECTION [CYRAMZA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1657781",
  "drug_name" : "50 ML RAMUCIRUMAB 10 MG\\/ML INJECTION [CYRAMZA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1657864",
  "drug_name" : "10 ML RITUXIMAB 10 MG\\/ML INJECTION [RITUXAN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1657868",
  "drug_name" : "50 ML RITUXIMAB 10 MG\\/ML INJECTION [RITUXAN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1658044",
  "drug_name" : "50 ML OFATUMUMAB 20 MG\\/ML INJECTION [ARZERRA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1658048",
  "drug_name" : "5 ML OFATUMUMAB 20 MG\\/ML INJECTION [ARZERRA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1658087",
  "drug_name" : "ADO-TRASTUZUMAB EMTANSINE 100 MG INJECTION [KADCYLA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1658091",
  "drug_name" : "ADO-TRASTUZUMAB EMTANSINE 160 MG INJECTION [KADCYLA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1658102",
  "drug_name" : "1 ML HEPATITIS A VIRUS STRAIN CR 326F ANTIGEN, INACTIVATED 50 UNT\\/ML INJECTION [VAQTA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "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" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1658135",
  "drug_name" : "SILTUXIMAB 100 MG INJECTION [SYLVANT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1658141",
  "drug_name" : "SILTUXIMAB 400 MG INJECTION [SYLVANT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1658148",
  "drug_name" : "1 ML HEPATITIS B IMMUNE GLOBULIN 312 UNT\\/ML INJECTION [NABI-HB]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1658150",
  "drug_name" : "1 ML HEPATITIS B SURFACE ANTIGEN VACCINE 0.01 MG\\/ML INJECTION [RECOMBIVAX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1658155",
  "drug_name" : "0.5 ML HEPATITIS B SURFACE ANTIGEN VACCINE 0.01 MG\\/ML INJECTION [RECOMBIVAX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1658157",
  "drug_name" : "1 ML HEPATITIS B SURFACE ANTIGEN VACCINE 0.02 MG\\/ML INJECTION [ENGERIX-B]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1658221",
  "drug_name" : "2 ML MAGNESIUM SULFATE 500 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1658241",
  "drug_name" : "0.5 ML YELLOW FEVER VIRUS STRAIN 17D-204 LIVE ANTIGEN 4000 UNT\\/ML INJECTION [YF-VAX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1658325",
  "drug_name" : "BREXPIPRAZOLE 0.25 MG ORAL TABLET [REXULTI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1658329",
  "drug_name" : "BREXPIPRAZOLE 0.5 MG ORAL TABLET [REXULTI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1658333",
  "drug_name" : "BREXPIPRAZOLE 1 MG ORAL TABLET [REXULTI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1658337",
  "drug_name" : "BREXPIPRAZOLE 2 MG ORAL TABLET [REXULTI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1658341",
  "drug_name" : "BREXPIPRAZOLE 3 MG ORAL TABLET [REXULTI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1658345",
  "drug_name" : "BREXPIPRAZOLE 4 MG ORAL TABLET [REXULTI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1658637",
  "drug_name" : "1 ML HEPARIN SODIUM, PORCINE 10000 UNT\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1658647",
  "drug_name" : "2 ML HEPARIN SODIUM, PORCINE 1000 UNT\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1658690",
  "drug_name" : "1000 ML HEPARIN SODIUM, PORCINE 2 UNT\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1658692",
  "drug_name" : "500 ML HEPARIN SODIUM, PORCINE 2 UNT\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1658717",
  "drug_name" : "250 ML HEPARIN SODIUM, PORCINE 100 UNT\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1659131",
  "drug_name" : "PIPERACILLIN 2000 MG \\/ TAZOBACTAM 250 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1659137",
  "drug_name" : "PIPERACILLIN 3000 MG \\/ TAZOBACTAM 375 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1659149",
  "drug_name" : "PIPERACILLIN 4000 MG \\/ TAZOBACTAM 500 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1659195",
  "drug_name" : "500 ML HEPARIN SODIUM, PORCINE 50 UNT\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1659283",
  "drug_name" : "CEFTAZIDIME 1000 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1659292",
  "drug_name" : "CEFTAZIDIME 1000 MG INJECTION [TAZICEF]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1659294",
  "drug_name" : "CEFTAZIDIME 2000 MG INJECTION [TAZICEF]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1659592",
  "drug_name" : "AMPICILLIN 1000 MG \\/ SULBACTAM 500 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1659598",
  "drug_name" : "AMPICILLIN 2000 MG \\/ SULBACTAM 1000 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1659814",
  "drug_name" : "ARIPIPRAZOLE 400 MG INJECTION [ABILIFY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1659818",
  "drug_name" : "ARIPIPRAZOLE 300 MG INJECTION [ABILIFY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1659927",
  "drug_name" : "SONIDEGIB 200 MG ORAL CAPSULE [ODOMZO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1659929",
  "drug_name" : "1 ML NALOXONE HYDROCHLORIDE 0.4 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1660004",
  "drug_name" : "THIOTEPA 100 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1660009",
  "drug_name" : "THIOTEPA 15 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1662285",
  "drug_name" : "300 ML LINEZOLID 2 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1663224",
  "drug_name" : "3 ML AMIODARONE HYDROCHLORIDE 50 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1663244",
  "drug_name" : "9 ML AMIODARONE HYDROCHLORIDE 50 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1663248",
  "drug_name" : "18 ML AMIODARONE HYDROCHLORIDE 50 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1664440",
  "drug_name" : "24 HR TACROLIMUS 4 MG EXTENDED RELEASE ORAL TABLET [ENVARSUS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1664448",
  "drug_name" : "OXYCODONE HYDROCHLORIDE 5 MG ORAL TABLET [OXAYDO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1664458",
  "drug_name" : "24 HR TACROLIMUS 0.75 MG EXTENDED RELEASE ORAL TABLET [ENVARSUS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1664463",
  "drug_name" : "24 HR TACROLIMUS 1 MG EXTENDED RELEASE ORAL TABLET [ENVARSUS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1664981",
  "drug_name" : "AZTREONAM 1000 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1665005",
  "drug_name" : "CEFTRIAXONE 500 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1665021",
  "drug_name" : "CEFTRIAXONE 1000 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1665046",
  "drug_name" : "CEFTRIAXONE 2000 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1665050",
  "drug_name" : "CEFAZOLIN 1000 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1665052",
  "drug_name" : "CEFAZOLIN 500 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1665088",
  "drug_name" : "CEFEPIME 2000 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1665093",
  "drug_name" : "CEFEPIME 1000 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1665102",
  "drug_name" : "CEFOXITIN 1000 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1665107",
  "drug_name" : "CEFOXITIN 2000 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1665188",
  "drug_name" : "1 ML LORAZEPAM 2 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1665210",
  "drug_name" : "100 ML CIPROFLOXACIN 2 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1665212",
  "drug_name" : "200 ML CIPROFLOXACIN 2 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1665326",
  "drug_name" : "1 ML LORAZEPAM 4 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1665444",
  "drug_name" : "CEFUROXIME 1500 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1665449",
  "drug_name" : "CEFUROXIME 750 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1665459",
  "drug_name" : "2 ML KETOROLAC TROMETHAMINE 30 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1665461",
  "drug_name" : "1 ML KETOROLAC TROMETHAMINE 30 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1665497",
  "drug_name" : "50 ML LEVOFLOXACIN 5 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1665507",
  "drug_name" : "100 ML LEVOFLOXACIN 5 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1665515",
  "drug_name" : "150 ML LEVOFLOXACIN 5 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1665900",
  "drug_name" : "1 ML EVOLOCUMAB 140 MG\\/ML AUTO-INJECTOR [REPATHA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1666332",
  "drug_name" : "TICAGRELOR 60 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1666372",
  "drug_name" : "1 ML PHENYLEPHRINE HYDROCHLORIDE 10 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1666798",
  "drug_name" : "2 ML MIDAZOLAM 1 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1666823",
  "drug_name" : "2 ML MIDAZOLAM 5 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1667666",
  "drug_name" : "CARIPRAZINE 1.5 MG ORAL CAPSULE [VRAYLAR]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1667670",
  "drug_name" : "CARIPRAZINE 3 MG ORAL CAPSULE [VRAYLAR]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1667674",
  "drug_name" : "CARIPRAZINE 4.5 MG ORAL CAPSULE [VRAYLAR]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1667678",
  "drug_name" : "CARIPRAZINE 6 MG ORAL CAPSULE [VRAYLAR]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1668238",
  "drug_name" : "AZITHROMYCIN 500 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1668267",
  "drug_name" : "ERYTHROMYCIN LACTOBIONATE 500 MG INJECTION [ERYTHROCIN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1670195",
  "drug_name" : "10 ML FOSPHENYTOIN SODIUM 75 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1670200",
  "drug_name" : "2 ML FOSPHENYTOIN SODIUM 75 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1670322",
  "drug_name" : "TIPIRACIL 6.14 MG \\/ TRIFLURIDINE 15 MG ORAL TABLET [LONSURF]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1670324",
  "drug_name" : "TIPIRACIL 8.19 MG \\/ TRIFLURIDINE 20 MG ORAL TABLET [LONSURF]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1670351",
  "drug_name" : "2 ML PHENYTOIN SODIUM 50 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1672917",
  "drug_name" : "10 ML BUPIVACAINE HYDROCHLORIDE 5 MG\\/ML \\/ EPINEPHRINE 0.005 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1673274",
  "drug_name" : "1.6 ML ARIPIPRAZOLE LAUROXIL 276 MG\\/ML PREFILLED SYRINGE [ARISTADA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1673278",
  "drug_name" : "2.4 ML ARIPIPRAZOLE LAUROXIL 276 MG\\/ML PREFILLED SYRINGE [ARISTADA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1673280",
  "drug_name" : "3.2 ML ARIPIPRAZOLE LAUROXIL 276 MG\\/ML PREFILLED SYRINGE [ARISTADA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1673296",
  "drug_name" : "10 ML BUPIVACAINE HYDROCHLORIDE 5 MG\\/ML \\/ EPINEPHRINE 0.005 MG\\/ML INJECTION [SENSORCAINE WITH EPINEPHRINE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1716063",
  "drug_name" : "BUPRENORPHINE 0.15 MG BUCCAL FILM [BELBUCA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1716067",
  "drug_name" : "BUPRENORPHINE 0.3 MG BUCCAL FILM [BELBUCA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1716071",
  "drug_name" : "BUPRENORPHINE 0.45 MG BUCCAL FILM [BELBUCA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1716075",
  "drug_name" : "BUPRENORPHINE 0.6 MG BUCCAL FILM [BELBUCA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1716079",
  "drug_name" : "BUPRENORPHINE 0.075 MG BUCCAL FILM [BELBUCA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1716083",
  "drug_name" : "BUPRENORPHINE 0.75 MG BUCCAL FILM [BELBUCA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1716090",
  "drug_name" : "BUPRENORPHINE 0.9 MG BUCCAL FILM [BELBUCA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1716099",
  "drug_name" : "BETAMETHASONE DIPROPIONATE 0.643 MG\\/ML \\/ CALCIPOTRIENE 0.05 MG\\/ML TOPICAL FOAM [ENSTILAR]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1718594",
  "drug_name" : "TRABECTEDIN 1 MG INJECTION [YONDELIS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1718760",
  "drug_name" : "20 ML 6-AMINOCAPROIC ACID 250 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1718936",
  "drug_name" : "OLANZAPINE 210 MG INJECTION [ZYPREXA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1719000",
  "drug_name" : "GEMCITABINE 200 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1719003",
  "drug_name" : "GEMCITABINE 1000 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1719005",
  "drug_name" : "GEMCITABINE 2000 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1719286",
  "drug_name" : "10 ML FUROSEMIDE 10 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1719766",
  "drug_name" : "ELUXADOLINE 100 MG ORAL TABLET [VIBERZI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1719777",
  "drug_name" : "10 ML IRINOTECAN HYDROCHLORIDE LIPOSOME 4.3 MG\\/ML INJECTION [ONIVYDE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1719803",
  "drug_name" : "1 ML HALOPERIDOL DECANOATE 100 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1719862",
  "drug_name" : "1 ML HALOPERIDOL DECANOATE 50 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1720268",
  "drug_name" : "0.45 ML ASFOTASE ALFA 40 MG\\/ML INJECTION [STRENSIQ]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1720272",
  "drug_name" : "0.7 ML ASFOTASE ALFA 40 MG\\/ML INJECTION [STRENSIQ]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1720276",
  "drug_name" : "1 ML ASFOTASE ALFA 40 MG\\/ML INJECTION [STRENSIQ]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1720280",
  "drug_name" : "0.8 ML ASFOTASE ALFA 100 MG\\/ML INJECTION [STRENSIQ]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1720760",
  "drug_name" : "LEVOLEUCOVORIN 50 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1720960",
  "drug_name" : "26.3 ML GEMCITABINE 38 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1720975",
  "drug_name" : "52.6 ML GEMCITABINE 38 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1720977",
  "drug_name" : "5.26 ML GEMCITABINE 38 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1721314",
  "drug_name" : "200 ML FLUCONAZOLE 2 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1721315",
  "drug_name" : "100 ML FLUCONAZOLE 2 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1721458",
  "drug_name" : "NAFCILLIN 1000 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1721460",
  "drug_name" : "NAFCILLIN 2000 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1721473",
  "drug_name" : "AMPICILLIN 250 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1721474",
  "drug_name" : "AMPICILLIN 500 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1721475",
  "drug_name" : "AMPICILLIN 1000 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1721476",
  "drug_name" : "AMPICILLIN 2000 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1721571",
  "drug_name" : "OSIMERTINIB 40 MG ORAL TABLET [TAGRISSO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1721583",
  "drug_name" : "OSIMERTINIB 80 MG ORAL TABLET [TAGRISSO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1721619",
  "drug_name" : "COBICISTAT 150 MG \\/ ELVITEGRAVIR 150 MG \\/ EMTRICITABINE 200 MG \\/ TENOFOVIR ALAFENAMIDE 10 MG ORAL TABLET [GENVOYA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1721690",
  "drug_name" : "1 ML EPOETIN ALFA 10000 UNT\\/ML INJECTION [PROCRIT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1721956",
  "drug_name" : "5 ML DARATUMUMAB 20 MG\\/ML INJECTION [DARZALEX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1721965",
  "drug_name" : "MICROGESTIN 24 FE 1\\/20 28 DAY PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1722376",
  "drug_name" : "COBIMETINIB 20 MG ORAL TABLET [COTELLIC]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1722919",
  "drug_name" : "CEFOTETAN 1000 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1722921",
  "drug_name" : "CEFOTETAN 2000 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1722934",
  "drug_name" : "MEROPENEM 500 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1722939",
  "drug_name" : "MEROPENEM 1000 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1723156",
  "drug_name" : "2 ML AMIKACIN 250 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1723160",
  "drug_name" : "4 ML AMIKACIN 250 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1723189",
  "drug_name" : "8 ML ZIV-AFLIBERCEPT 25 MG\\/ML INJECTION [ZALTRAP]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1723194",
  "drug_name" : "4 ML ZIV-AFLIBERCEPT 25 MG\\/ML INJECTION [ZALTRAP]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1723476",
  "drug_name" : "DABIGATRAN ETEXILATE 110 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1723478",
  "drug_name" : "DABIGATRAN ETEXILATE 110 MG ORAL CAPSULE [PRADAXA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1723750",
  "drug_name" : "50 ML NECITUMUMAB 16 MG\\/ML INJECTION [PORTRAZZA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1723763",
  "drug_name" : "IXAZOMIB 2.3 MG ORAL CAPSULE [NINLARO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1723767",
  "drug_name" : "IXAZOMIB 3 MG ORAL CAPSULE [NINLARO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1723772",
  "drug_name" : "IXAZOMIB 4 MG ORAL CAPSULE [NINLARO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1724668",
  "drug_name" : "10 ML AMINOPHYLLINE 25 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1724784",
  "drug_name" : "2 ML BUPIVACAINE HYDROCHLORIDE 7.5 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1724787",
  "drug_name" : "10 ML BUPIVACAINE HYDROCHLORIDE 7.5 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1724809",
  "drug_name" : "10 ML BUPIVACAINE HYDROCHLORIDE 7.5 MG\\/ML INJECTION [SENSORCAINE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1724881",
  "drug_name" : "10 ML BUPIVACAINE HYDROCHLORIDE 5 MG\\/ML INJECTION [SENSORCAINE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1725064",
  "drug_name" : "NALOXONE HYDROCHLORIDE 40 MG\\/ML NASAL SPRAY [NARCAN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1725078",
  "drug_name" : "10 ML BUPIVACAINE HYDROCHLORIDE 2.5 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1725175",
  "drug_name" : "10 ML BUPIVACAINE HYDROCHLORIDE 2.5 MG\\/ML INJECTION [SENSORCAINE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1726097",
  "drug_name" : "BENDAMUSTINE HYDROCHLORIDE 25 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1726102",
  "drug_name" : "BENDAMUSTINE HYDROCHLORIDE 25 MG\\/ML INJECTABLE SOLUTION [BENDEKA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1726115",
  "drug_name" : "ELOTUZUMAB 300 MG INJECTION [EMPLICITI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1726119",
  "drug_name" : "ELOTUZUMAB 400 MG INJECTION [EMPLICITI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1726204",
  "drug_name" : "CILASTATIN 250 MG \\/ IMIPENEM 250 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1726214",
  "drug_name" : "CILASTATIN 500 MG \\/ IMIPENEM 500 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1726268",
  "drug_name" : "IMIGLUCERASE 400 UNT INJECTION [CEREZYME]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1726274",
  "drug_name" : "IXABEPILONE 45 MG INJECTION [IXEMPRA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1726319",
  "drug_name" : "2 ML IRINOTECAN HYDROCHLORIDE 20 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1726324",
  "drug_name" : "5 ML IRINOTECAN HYDROCHLORIDE 20 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1726333",
  "drug_name" : "15 ML IRINOTECAN HYDROCHLORIDE 20 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1726440",
  "drug_name" : "20 ML DARATUMUMAB 20 MG\\/ML INJECTION [DARZALEX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1726492",
  "drug_name" : "25 ML IRINOTECAN HYDROCHLORIDE 20 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1726639",
  "drug_name" : "PONATINIB 30 MG ORAL TABLET [ICLUSIG]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1726673",
  "drug_name" : "BLEOMYCIN 15 UNT INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1726676",
  "drug_name" : "BLEOMYCIN 30 UNT INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1726984",
  "drug_name" : "10 ML SEBELIPASE ALFA 2 MG\\/ML INJECTION [KANUMA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1727485",
  "drug_name" : "ALECTINIB 150 MG ORAL CAPSULE [ALECENSA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1727569",
  "drug_name" : "4 ML BUMETANIDE 0.25 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1728072",
  "drug_name" : "PEMETREXED 500 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  }, {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1728075",
  "drug_name" : "PEMETREXED 500 MG INJECTION [ALIMTA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1728077",
  "drug_name" : "PEMETREXED 100 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1729013",
  "drug_name" : "SELEXIPAG 1 MG ORAL TABLET [UPTRAVI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1729029",
  "drug_name" : "SELEXIPAG 1.2 MG ORAL TABLET [UPTRAVI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1729033",
  "drug_name" : "SELEXIPAG 1.4 MG ORAL TABLET [UPTRAVI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1729047",
  "drug_name" : "SELEXIPAG 1.6 MG ORAL TABLET [UPTRAVI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1729053",
  "drug_name" : "SELEXIPAG 0.2 MG ORAL TABLET [UPTRAVI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1729057",
  "drug_name" : "SELEXIPAG 0.4 MG ORAL TABLET [UPTRAVI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1729061",
  "drug_name" : "SELEXIPAG 0.6 MG ORAL TABLET [UPTRAVI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1729065",
  "drug_name" : "SELEXIPAG 0.8 MG ORAL TABLET [UPTRAVI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1729076",
  "drug_name" : "UPTRAVI TITRATION PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1729205",
  "drug_name" : "2 ML ENALAPRILAT 1.25 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1729418",
  "drug_name" : "1 ML VINORELBINE 10 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1729422",
  "drug_name" : "5 ML VINORELBINE 10 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1730076",
  "drug_name" : "1 ML CHLORPROMAZINE HYDROCHLORIDE 25 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1730078",
  "drug_name" : "2 ML CHLORPROMAZINE HYDROCHLORIDE 25 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1731020",
  "drug_name" : "LEVETIRACETAM 500 MG ORAL TABLET [ROWEEPRA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1731077",
  "drug_name" : "FOSAPREPITANT 150 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1731317",
  "drug_name" : "3 ML INSULIN, REGULAR, HUMAN 500 UNT\\/ML PEN INJECTOR [HUMULIN R]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1731338",
  "drug_name" : "DACARBAZINE 200 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1731340",
  "drug_name" : "DACARBAZINE 100 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1731345",
  "drug_name" : "DEFEROXAMINE MESYLATE 2000 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1731350",
  "drug_name" : "DEFEROXAMINE MESYLATE 500 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1731355",
  "drug_name" : "5 ML CYTARABINE 20 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1732165",
  "drug_name" : "INCOBOTULINUMTOXINA 200 UNT INJECTION [XEOMIN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1732183",
  "drug_name" : "25 ML EPIRUBICIN HYDROCHLORIDE 2 MG\\/ML INJECTION [ELLENCE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1732187",
  "drug_name" : "100 ML EPIRUBICIN HYDROCHLORIDE 2 MG\\/ML INJECTION [ELLENCE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1734090",
  "drug_name" : "10 ML ROPIVACAINE HYDROCHLORIDE 10 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1734475",
  "drug_name" : "30 ML ROPIVACAINE HYDROCHLORIDE 5 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1734683",
  "drug_name" : "ERTAPENEM 1000 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1734917",
  "drug_name" : "CYCLOPHOSPHAMIDE 500 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1734919",
  "drug_name" : "CYCLOPHOSPHAMIDE 1000 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1734921",
  "drug_name" : "CYCLOPHOSPHAMIDE 2000 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1734932",
  "drug_name" : "10 ML ACYCLOVIR 50 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1736044",
  "drug_name" : "LEVETIRACETAM 1000 MG TABLET FOR ORAL SUSPENSION [SPRITAM]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1736047",
  "drug_name" : "LEVETIRACETAM 250 MG TABLET FOR ORAL SUSPENSION [SPRITAM]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1736050",
  "drug_name" : "LEVETIRACETAM 500 MG TABLET FOR ORAL SUSPENSION [SPRITAM]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1736053",
  "drug_name" : "LEVETIRACETAM 750 MG TABLET FOR ORAL SUSPENSION [SPRITAM]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1736541",
  "drug_name" : "250 ML ESMOLOL HYDROCHLORIDE 10 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1736546",
  "drug_name" : "10 ML ESMOLOL HYDROCHLORIDE 10 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1736585",
  "drug_name" : "DEXRAZOXANE 250 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1736590",
  "drug_name" : "DEXRAZOXANE 500 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1736776",
  "drug_name" : "10 ML OXALIPLATIN 5 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1736781",
  "drug_name" : "20 ML OXALIPLATIN 5 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1736784",
  "drug_name" : "OXALIPLATIN 50 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1736786",
  "drug_name" : "OXALIPLATIN 100 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1736854",
  "drug_name" : "CISPLATIN 50 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1736931",
  "drug_name" : "1 ML PARICALCITOL 0.002 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1737244",
  "drug_name" : "2 ML CLINDAMYCIN 150 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1737343",
  "drug_name" : "50 ML LIDOCAINE HYDROCHLORIDE 5 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1737449",
  "drug_name" : "10 ML PAMIDRONATE DISODIUM 3 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1737451",
  "drug_name" : "10 ML PAMIDRONATE DISODIUM 6 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1737453",
  "drug_name" : "10 ML PAMIDRONATE DISODIUM 9 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1737578",
  "drug_name" : "4 ML CLINDAMYCIN 150 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1737581",
  "drug_name" : "6 ML CLINDAMYCIN 150 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1737636",
  "drug_name" : "20 ML LIDOCAINE HYDROCHLORIDE 15 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1737723",
  "drug_name" : "250 ML LIDOCAINE HYDROCHLORIDE 8 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1737744",
  "drug_name" : "500 ML LIDOCAINE HYDROCHLORIDE 4 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1738483",
  "drug_name" : "PAROXETINE HYDROCHLORIDE 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1738495",
  "drug_name" : "PAROXETINE HYDROCHLORIDE 20 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1738503",
  "drug_name" : "PAROXETINE HYDROCHLORIDE 30 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1738511",
  "drug_name" : "PAROXETINE HYDROCHLORIDE 40 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1738589",
  "drug_name" : "HYDROCORTISONE 1000 MG INJECTION [SOLU-CORTEF]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1738592",
  "drug_name" : "HYDROCORTISONE 250 MG INJECTION [SOLU-CORTEF]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1738596",
  "drug_name" : "HYDROCORTISONE 500 MG INJECTION [SOLU-CORTEF]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1738803",
  "drug_name" : "24 HR PAROXETINE HYDROCHLORIDE 12.5 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1738805",
  "drug_name" : "24 HR PAROXETINE HYDROCHLORIDE 25 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1738807",
  "drug_name" : "24 HR PAROXETINE HYDROCHLORIDE 37.5 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1739766",
  "drug_name" : "BRIVARACETAM 10 MG ORAL TABLET [BRIVIACT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1739770",
  "drug_name" : "BRIVARACETAM 100 MG ORAL TABLET [BRIVIACT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1739774",
  "drug_name" : "BRIVARACETAM 25 MG ORAL TABLET [BRIVIACT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1739778",
  "drug_name" : "BRIVARACETAM 50 MG ORAL TABLET [BRIVIACT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1739782",
  "drug_name" : "BRIVARACETAM 75 MG ORAL TABLET [BRIVIACT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1739788",
  "drug_name" : "BRIVARACETAM 10 MG\\/ML ORAL SOLUTION [BRIVIACT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1739800",
  "drug_name" : "URIDINE TRIACETATE 10000 MG ORAL GRANULES [VISTOGARD]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1740467",
  "drug_name" : "2 ML ONDANSETRON 2 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1740864",
  "drug_name" : "FLUDARABINE PHOSPHATE 50 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1740865",
  "drug_name" : "2 ML FLUDARABINE PHOSPHATE 25 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1740894",
  "drug_name" : "MITOMYCIN 5 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1740898",
  "drug_name" : "MITOMYCIN 40 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1740900",
  "drug_name" : "MITOMYCIN 20 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1741049",
  "drug_name" : "24 HR TOFACITINIB 11 MG EXTENDED RELEASE ORAL TABLET [XELJANZ]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1741739",
  "drug_name" : "EMTRICITABINE 200 MG \\/ RILPIVIRINE 25 MG \\/ TENOFOVIR ALAFENAMIDE 25 MG ORAL TABLET [ODEFSEY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1741747",
  "drug_name" : "VRAYLAR 1.5\\/3 MIXED PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1743547",
  "drug_name" : "OXACILLIN 1000 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1743549",
  "drug_name" : "OXACILLIN 2000 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1743704",
  "drug_name" : "METHYLPREDNISOLONE 125 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1743833",
  "drug_name" : "2 ML FAMOTIDINE 10 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1743869",
  "drug_name" : "250 ML DOPAMINE HYDROCHLORIDE 0.8 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1743877",
  "drug_name" : "250 ML DOPAMINE HYDROCHLORIDE 1.6 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1743941",
  "drug_name" : "5 ML DOPAMINE HYDROCHLORIDE 40 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1744001",
  "drug_name" : "EMTRICITABINE 100 MG \\/ TENOFOVIR DISOPROXIL FUMARATE 150 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1744005",
  "drug_name" : "EMTRICITABINE 133 MG \\/ TENOFOVIR DISOPROXIL FUMARATE 200 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1744009",
  "drug_name" : "EMTRICITABINE 167 MG \\/ TENOFOVIR DISOPROXIL FUMARATE 250 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1745090",
  "drug_name" : "MELPHALAN 50 MG INJECTION [EVOMELA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1745091",
  "drug_name" : "LIDOCAINE 0.05 MG\\/MG MEDICATED PATCH",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1745108",
  "drug_name" : "1 ML IXEKIZUMAB 80 MG\\/ML AUTO-INJECTOR [TALTZ]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1745114",
  "drug_name" : "1 ML IXEKIZUMAB 80 MG\\/ML PREFILLED SYRINGE [TALTZ]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1746898",
  "drug_name" : "10 ML RESLIZUMAB 10 MG\\/ML INJECTION [CINQAIR]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1747294",
  "drug_name" : "2 ML IBUPROFEN 10 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1747567",
  "drug_name" : "VENETOCLAX 100 MG ORAL TABLET [VENCLEXTA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1747577",
  "drug_name" : "VENETOCLAX 10 MG ORAL TABLET [VENCLEXTA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1747579",
  "drug_name" : "VENETOCLAX 50 MG ORAL TABLET [VENCLEXTA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1747580",
  "drug_name" : "VENCLEXTA STARTING PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1747697",
  "drug_name" : "EMTRICITABINE 200 MG \\/ TENOFOVIR ALAFENAMIDE 25 MG ORAL TABLET [DESCOVY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1790095",
  "drug_name" : "DOXORUBICIN HYDROCHLORIDE 50 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1790097",
  "drug_name" : "5 ML DOXORUBICIN HYDROCHLORIDE 2 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1790103",
  "drug_name" : "DOXORUBICIN HYDROCHLORIDE 10 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1790115",
  "drug_name" : "10 ML DOXORUBICIN HYDROCHLORIDE LIPOSOME 2 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1790126",
  "drug_name" : "PERAMPANEL 0.5 MG\\/ML ORAL SUSPENSION [FYCOMPA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1790127",
  "drug_name" : "25 ML DOXORUBICIN HYDROCHLORIDE LIPOSOME 2 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1790167",
  "drug_name" : "CABOZANTINIB 20 MG ORAL TABLET [CABOMETYX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1790171",
  "drug_name" : "CABOZANTINIB 40 MG ORAL TABLET [CABOMETYX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1790175",
  "drug_name" : "CABOZANTINIB 60 MG ORAL TABLET [CABOMETYX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1790347",
  "drug_name" : "RASBURICASE 1.5 MG INJECTION [ELITEK]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1790546",
  "drug_name" : "INFLIXIMAB-DYYB 100 MG INJECTION [INFLECTRA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1790886",
  "drug_name" : "VORTIOXETINE 10 MG ORAL TABLET [TRINTELLIX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1790890",
  "drug_name" : "VORTIOXETINE 20 MG ORAL TABLET [TRINTELLIX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1790892",
  "drug_name" : "VORTIOXETINE 5 MG ORAL TABLET [TRINTELLIX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1791229",
  "drug_name" : "5 ML DILTIAZEM HYDROCHLORIDE 5 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1791232",
  "drug_name" : "10 ML DILTIAZEM HYDROCHLORIDE 5 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1791233",
  "drug_name" : "25 ML DILTIAZEM HYDROCHLORIDE 5 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1791240",
  "drug_name" : "DILTIAZEM HYDROCHLORIDE 100 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1791404",
  "drug_name" : "250 ML MANNITOL 200 MG\\/ML INJECTION [OSMITROL]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1791408",
  "drug_name" : "500 ML MANNITOL 200 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1791493",
  "drug_name" : "20 ML IDARUBICIN HYDROCHLORIDE 1 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1791495",
  "drug_name" : "20 ML IDARUBICIN HYDROCHLORIDE 1 MG\\/ML INJECTION [IDAMYCIN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1791498",
  "drug_name" : "10 ML IDARUBICIN HYDROCHLORIDE 1 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1791499",
  "drug_name" : "10 ML IDARUBICIN HYDROCHLORIDE 1 MG\\/ML INJECTION [IDAMYCIN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1791500",
  "drug_name" : "5 ML IDARUBICIN HYDROCHLORIDE 1 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1791501",
  "drug_name" : "5 ML IDARUBICIN HYDROCHLORIDE 1 MG\\/ML INJECTION [IDAMYCIN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1791593",
  "drug_name" : "IFOSFAMIDE 1000 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1791597",
  "drug_name" : "60 ML IFOSFAMIDE 50 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1791599",
  "drug_name" : "20 ML IFOSFAMIDE 50 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1791701",
  "drug_name" : "10 ML FLUOROURACIL 50 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1791736",
  "drug_name" : "20 ML FLUOROURACIL 50 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1791840",
  "drug_name" : "100 ML MILRINONE LACTATE 0.2 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1791842",
  "drug_name" : "200 ML MILRINONE LACTATE 0.2 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1791854",
  "drug_name" : "10 ML MILRINONE LACTATE 1 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1792144",
  "drug_name" : "1 ML TRIAMCINOLONE ACETONIDE 40 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1792393",
  "drug_name" : "LENVIMA 18 MG (AS LENVATINIB MESYLATE) DAILY DOSE 30 DAY SUPPLY PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1792785",
  "drug_name" : "20 ML ATEZOLIZUMAB 60 MG\\/ML INJECTION [TECENTRIQ]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1794184",
  "drug_name" : "20 ML CHLOROPROCAINE HYDROCHLORIDE 20 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1794554",
  "drug_name" : "1 ML HYDROXYZINE HYDROCHLORIDE 50 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1794886",
  "drug_name" : "500 ML GLUCOSE 50 MG\\/ML \\/ SODIUM CHLORIDE 2 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1795252",
  "drug_name" : "500 ML GLUCOSE 50 MG\\/ML \\/ SODIUM CHLORIDE 4.5 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1795346",
  "drug_name" : "1000 ML GLUCOSE 50 MG\\/ML \\/ SODIUM CHLORIDE 9 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1795470",
  "drug_name" : "1000 ML GLUCOSE 25 MG\\/ML \\/ SODIUM CHLORIDE 4.5 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1795477",
  "drug_name" : "500 ML GLUCOSE 100 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1795609",
  "drug_name" : "100 ML GLUCOSE 50 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1796079",
  "drug_name" : "DOLUTEGRAVIR 10 MG ORAL TABLET [TIVICAY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1796083",
  "drug_name" : "DOLUTEGRAVIR 25 MG ORAL TABLET [TIVICAY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1796419",
  "drug_name" : "1 ML PRALATREXATE 20 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1796421",
  "drug_name" : "1 ML PRALATREXATE 20 MG\\/ML INJECTION [FOLOTYN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1796424",
  "drug_name" : "2 ML PRALATREXATE 20 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1796425",
  "drug_name" : "2 ML PRALATREXATE 20 MG\\/ML INJECTION [FOLOTYN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1796665",
  "drug_name" : "LENVIMA 8 MG DAILY DOSE 30 DAY SUPPLY PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1797113",
  "drug_name" : "ESTRADIOL 0.01 MG VAGINAL INSERT [YUVAFEM]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1797833",
  "drug_name" : "IPRATROPIUM BROMIDE 0.021 MG\\/ACTUAT METERED DOSE NASAL SPRAY",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1797844",
  "drug_name" : "IPRATROPIUM BROMIDE 0.042 MG\\/ACTUAT METERED DOSE NASAL SPRAY",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1797865",
  "drug_name" : "MOMETASONE FUROATE 0.05 MG\\/ACTUAT METERED DOSE NASAL SPRAY",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1797867",
  "drug_name" : "AZELASTINE HYDROCHLORIDE 0.137 MG\\/ACTUAT METERED DOSE NASAL SPRAY",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1797880",
  "drug_name" : "NAFARELIN 0.2 MG\\/ACTUAT METERED DOSE NASAL SPRAY [SYNAREL]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1797907",
  "drug_name" : "FLUTICASONE PROPIONATE 0.05 MG\\/ACTUAT METERED DOSE NASAL SPRAY",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1798370",
  "drug_name" : "OBETICHOLIC ACID 5 MG ORAL TABLET [OCALIVA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1798375",
  "drug_name" : "OBETICHOLIC ACID 10 MG ORAL TABLET [OCALIVA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1799212",
  "drug_name" : "SOFOSBUVIR 400 MG \\/ VELPATASVIR 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1799218",
  "drug_name" : "SOFOSBUVIR 400 MG \\/ VELPATASVIR 100 MG ORAL TABLET [EPCLUSA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1799230",
  "drug_name" : "1 ML ABATACEPT 125 MG\\/ML AUTO-INJECTOR [ORENCIA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1799416",
  "drug_name" : "TOPOTECAN 4 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1799706",
  "drug_name" : "250 ML SOYBEAN OIL 200 MG\\/ML INJECTION [INTRALIPID]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1801144",
  "drug_name" : "DOXYCYCLINE HYCLATE 60 MG DELAYED RELEASE ORAL TABLET [DORYX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1801278",
  "drug_name" : "HUMIRA PSORIASIS STARTER PACK 40 MG\\/0.8 ML PEN (4 COUNT)",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1801279",
  "drug_name" : "SUGAR-FREE CHOLESTYRAMINE RESIN 4000 MG POWDER FOR ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1801283",
  "drug_name" : "EMOLLIENT FLUOCINONIDE 0.5 MG\\/ML TOPICAL CREAM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1801289",
  "drug_name" : "SMOKING CESSATION 12 HR BUPROPION HYDROCHLORIDE 150 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1801294",
  "drug_name" : "MICROENCAPSULATED POTASSIUM CHLORIDE 20 MEQ EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1801298",
  "drug_name" : "MICROENCAPSULATED POTASSIUM CHLORIDE 10 MEQ EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1803930",
  "drug_name" : "LEUCOVORIN 50 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1803932",
  "drug_name" : "LEUCOVORIN 100 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1803937",
  "drug_name" : "LEUCOVORIN 200 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1804758",
  "drug_name" : "AGALSIDASE BETA 35 MG INJECTION [FABRAZYME]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1804762",
  "drug_name" : "AGALSIDASE BETA 5 MG INJECTION [FABRAZYME]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1805001",
  "drug_name" : "BENDAMUSTINE HYDROCHLORIDE 100 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1805004",
  "drug_name" : "BENDAMUSTINE HYDROCHLORIDE 100 MG INJECTION [TREANDA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1805007",
  "drug_name" : "BENDAMUSTINE HYDROCHLORIDE 25 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1805009",
  "drug_name" : "BENDAMUSTINE HYDROCHLORIDE 25 MG INJECTION [TREANDA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1806181",
  "drug_name" : "30\\/70 RELEASE 24 HR METHYLPHENIDATE HYDROCHLORIDE 10 MG EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1806187",
  "drug_name" : "30\\/70 RELEASE 24 HR METHYLPHENIDATE HYDROCHLORIDE 20 MG EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1806189",
  "drug_name" : "30\\/70 RELEASE 24 HR METHYLPHENIDATE HYDROCHLORIDE 30 MG EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1806191",
  "drug_name" : "30\\/70 RELEASE 24 HR METHYLPHENIDATE HYDROCHLORIDE 40 MG EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1806193",
  "drug_name" : "30\\/70 RELEASE 24 HR METHYLPHENIDATE HYDROCHLORIDE 50 MG EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1806197",
  "drug_name" : "30\\/70 RELEASE 24 HR METHYLPHENIDATE HYDROCHLORIDE 60 MG EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1806200",
  "drug_name" : "40\\/60 RELEASE 24 HR METHYLPHENIDATE HYDROCHLORIDE 10 MG EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1806202",
  "drug_name" : "40\\/60 RELEASE 24 HR METHYLPHENIDATE HYDROCHLORIDE 20 MG EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1806204",
  "drug_name" : "40\\/60 RELEASE 24 HR METHYLPHENIDATE HYDROCHLORIDE 50 MG EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1806206",
  "drug_name" : "40\\/60 RELEASE 24 HR METHYLPHENIDATE HYDROCHLORIDE 30 MG EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1806208",
  "drug_name" : "40\\/60 RELEASE 24 HR METHYLPHENIDATE HYDROCHLORIDE 60 MG EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1806210",
  "drug_name" : "40\\/60 RELEASE 24 HR METHYLPHENIDATE HYDROCHLORIDE 40 MG EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1806937",
  "drug_name" : "CARFILZOMIB 30 MG INJECTION [KYPROLIS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1806942",
  "drug_name" : "CARFILZOMIB 60 MG INJECTION [KYPROLIS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1807513",
  "drug_name" : "VANCOMYCIN 1000 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1807516",
  "drug_name" : "VANCOMYCIN 500 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1807552",
  "drug_name" : "1000 ML SODIUM CHLORIDE 4.5 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1807632",
  "drug_name" : "100 ML SODIUM CHLORIDE 9 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1807637",
  "drug_name" : "10 ML SODIUM CHLORIDE 9 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1809034",
  "drug_name" : "2 ML IMMUNOGLOBULIN G, HUMAN 180 MG\\/ML INJECTION [GAMASTAN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1809083",
  "drug_name" : "5 ML SULFAMETHOXAZOLE 80 MG\\/ML \\/ TRIMETHOPRIM 16 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1809436",
  "drug_name" : "10 ML IMMUNOGLOBULIN G, HUMAN 100 MG\\/ML INJECTION [GAMMAKED]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1809513",
  "drug_name" : "200 ML IMMUNOGLOBULIN G, HUMAN 50 MG\\/ML INJECTION [GAMMAPLEX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1809580",
  "drug_name" : "10 ML IMMUNOGLOBULIN G, HUMAN 100 MG\\/ML INJECTION [GAMUNEX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1809643",
  "drug_name" : "20 ML IMMUNOGLOBULIN G, HUMAN 50 MG\\/ML INJECTION [OCTAGAM]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1809667",
  "drug_name" : "25 ML IMMUNOGLOBULIN G, HUMAN 100 MG\\/ML INJECTION [GAMMAGARD]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1809730",
  "drug_name" : "IMMUNOGLOBULIN G, HUMAN 5000 MG INJECTION [GAMMAGARD]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1809738",
  "drug_name" : "IMMUNOGLOBULIN G, HUMAN 10000 MG INJECTION [GAMMAGARD]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1810578",
  "drug_name" : "2 ML ETEPLIRSEN 50 MG\\/ML INJECTION [EXONDYS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1810582",
  "drug_name" : "10 ML ETEPLIRSEN 50 MG\\/ML INJECTION [EXONDYS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1811180",
  "drug_name" : "ICOSAPENT ETHYL 500 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1811257",
  "drug_name" : "26 ML USTEKINUMAB 5 MG\\/ML INJECTION [STELARA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1812011",
  "drug_name" : "OSMOTIC 24 HR NIFEDIPINE 30 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1812013",
  "drug_name" : "OSMOTIC 24 HR NIFEDIPINE 60 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1812015",
  "drug_name" : "OSMOTIC 24 HR NIFEDIPINE 90 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1812095",
  "drug_name" : "1 ML DEXAMETHASONE PHOSPHATE 4 MG\\/ML PREFILLED SYRINGE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1812168",
  "drug_name" : "20 ML DOBUTAMINE 12.5 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1812194",
  "drug_name" : "1 ML DEXAMETHASONE PHOSPHATE 4 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1812419",
  "drug_name" : "SPRINKLE 24 HR TOPIRAMATE 200 MG EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1812421",
  "drug_name" : "SPRINKLE 24 HR TOPIRAMATE 25 MG EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1812425",
  "drug_name" : "SPRINKLE 24 HR TOPIRAMATE 50 MG EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1812427",
  "drug_name" : "SPRINKLE 24 HR TOPIRAMATE 100 MG EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1812434",
  "drug_name" : "SOFT GELATIN METHOXSALEN 10 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1812470",
  "drug_name" : "IVACAFTOR 125 MG \\/ LUMACAFTOR 100 MG ORAL TABLET [ORKAMBI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1812480",
  "drug_name" : "MITOMYCIN 20 MG INJECTION [MUTAMYCIN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1812482",
  "drug_name" : "MITOMYCIN 40 MG INJECTION [MUTAMYCIN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1812484",
  "drug_name" : "MITOMYCIN 5 MG INJECTION [MUTAMYCIN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1812951",
  "drug_name" : "VIBRIO CHOLERAE CVD 103-HGR STRAIN LIVE ANTIGEN 12000000 UNT\\/ML ORAL SUSPENSION [VAXCHORA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1855072",
  "drug_name" : "24 HR CALCIFEDIOL 0.03 MG EXTENDED RELEASE ORAL CAPSULE [RAYALDEE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1855527",
  "drug_name" : "HUMIRA PEDIATRIC CROHN'S DISEASE STARTER PACKAGE (2 COUNT)",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1856402",
  "drug_name" : "NYLIA 1\\/35 28 DAY PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1857913",
  "drug_name" : "MARAVIROC 25 MG ORAL TABLET [SELZENTRY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1857917",
  "drug_name" : "MARAVIROC 75 MG ORAL TABLET [SELZENTRY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1857925",
  "drug_name" : "MARAVIROC 20 MG\\/ML ORAL SOLUTION [SELZENTRY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1858267",
  "drug_name" : "TENOFOVIR ALAFENAMIDE 25 MG ORAL TABLET [VEMLIDY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1858833",
  "drug_name" : "12 HR TREPROSTINIL 5 MG EXTENDED RELEASE ORAL TABLET [ORENITRAM]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1859498",
  "drug_name" : "ELTROMBOPAG 25 MG POWDER FOR ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1860139",
  "drug_name" : "20 ML POTASSIUM CHLORIDE 2 MEQ\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1860239",
  "drug_name" : "100 ML POTASSIUM CHLORIDE 0.2 MEQ\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1860463",
  "drug_name" : "100 ML POTASSIUM CHLORIDE 0.4 MEQ\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1860480",
  "drug_name" : "1 ML DOCETAXEL 20 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1860485",
  "drug_name" : "4 ML DOCETAXEL 20 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1860619",
  "drug_name" : "2 ML DOCETAXEL 10 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1862590",
  "drug_name" : "RUCAPARIB 300 MG ORAL TABLET [RUBRACA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1862595",
  "drug_name" : "RUCAPARIB 200 MG ORAL TABLET [RUBRACA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1863343",
  "drug_name" : "1 ML VINCRISTINE SULFATE 1 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1863347",
  "drug_name" : "1 ML VINCRISTINE SULFATE 1 MG\\/ML INJECTION [VINCASAR]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1863605",
  "drug_name" : "1000 ML GLUCOSE 50 MG\\/ML \\/ POTASSIUM CHLORIDE 0.02 MEQ\\/ML \\/ SODIUM CHLORIDE 4.5 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1863973",
  "drug_name" : "1000 ML GLUCOSE 50 MG\\/ML \\/ POTASSIUM CHLORIDE 0.02 MEQ\\/ML \\/ SODIUM CHLORIDE 2.25 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1864326",
  "drug_name" : "1 ML CANAKINUMAB 150 MG\\/ML INJECTION [ILARIS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1864425",
  "drug_name" : "0.05 ML RANIBIZUMAB 10 MG\\/ML PREFILLED SYRINGE [LUCENTIS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1866515",
  "drug_name" : "30 ML MEPIVACAINE HYDROCHLORIDE 10 MG\\/ML INJECTION [POLOCAINE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1866531",
  "drug_name" : "20 ML MEPIVACAINE HYDROCHLORIDE 20 MG\\/ML INJECTION [POLOCAINE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1866543",
  "drug_name" : "1 ML NALBUPHINE HYDROCHLORIDE 10 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1866551",
  "drug_name" : "1 ML NALBUPHINE HYDROCHLORIDE 20 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1867544",
  "drug_name" : "POTASSIUM CHLORIDE 20 MEQ POWDER FOR ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1867594",
  "drug_name" : "10 ML BUPIVACAINE HYDROCHLORIDE 2.5 MG\\/ML \\/ EPINEPHRINE 0.005 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1867618",
  "drug_name" : "10 ML BUPIVACAINE HYDROCHLORIDE 2.5 MG\\/ML \\/ EPINEPHRINE 0.005 MG\\/ML INJECTION [SENSORCAINE WITH EPINEPHRINE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1867998",
  "drug_name" : "5 ML EPINEPHRINE 0.005 MG\\/ML \\/ LIDOCAINE HYDROCHLORIDE 15 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1868014",
  "drug_name" : "PIRFENIDONE 267 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1868018",
  "drug_name" : "PIRFENIDONE 801 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1869684",
  "drug_name" : "GLUTAMINE 5000 MG POWDER FOR ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1869699",
  "drug_name" : "LINACLOTIDE 0.072 MG ORAL CAPSULE [LINZESS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1870207",
  "drug_name" : "NDA019430 0.3 ML EPINEPHRINE 1 MG\\/ML AUTO-INJECTOR",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1870225",
  "drug_name" : "NDA020800 0.15 ML EPINEPHRINE 1 MG\\/ML AUTO-INJECTOR",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1870230",
  "drug_name" : "NDA020800 0.3 ML EPINEPHRINE 1 MG\\/ML AUTO-INJECTOR",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1870633",
  "drug_name" : "50 ML GENTAMICIN 1.2 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1870650",
  "drug_name" : "2 ML GENTAMICIN 40 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1870676",
  "drug_name" : "2 ML GENTAMICIN 10 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1870950",
  "drug_name" : "DEFLAZACORT 6 MG ORAL TABLET [EMFLAZA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1870954",
  "drug_name" : "DEFLAZACORT 18 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1870958",
  "drug_name" : "DEFLAZACORT 36 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1870960",
  "drug_name" : "DEFLAZACORT 36 MG ORAL TABLET [EMFLAZA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1870964",
  "drug_name" : "DEFLAZACORT 22.75 MG\\/ML ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1872261",
  "drug_name" : "1.5 ML BRODALUMAB 140 MG\\/ML PREFILLED SYRINGE [SILIQ]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1872384",
  "drug_name" : "15 ML SODIUM PHOSPHATE, DIBASIC 142 MG\\/ML \\/ SODIUM PHOSPHATE, MONOBASIC 276 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1872458",
  "drug_name" : "TELOTRISTAT ETHYL 250 MG ORAL TABLET [XERMELO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1873087",
  "drug_name" : "HUMIRA PREFILLED SYRINGE 80 MG\\/0.8 ML STARTER PACK - PEDIATRIC CROHN'S DISEASE (3 COUNT)",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1873765",
  "drug_name" : "PLECANATIDE 3 MG ORAL TABLET [TRULANCE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1873991",
  "drug_name" : "KISQALI 200 MG DAILY DOSE CARTON PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1873993",
  "drug_name" : "KISQALI 400 MG DAILY DOSE CARTON PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1873995",
  "drug_name" : "KISQALI 600 MG DAILY DOSE CARTON PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1874553",
  "drug_name" : "24 HR DESVENLAFAXINE SUCCINATE 100 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1874559",
  "drug_name" : "24 HR DESVENLAFAXINE SUCCINATE 50 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1875547",
  "drug_name" : "10 ML AVELUMAB 20 MG\\/ML INJECTION [BAVENCIO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1876385",
  "drug_name" : "10 ML OCRELIZUMAB 30 MG\\/ML INJECTION [OCREVUS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1876406",
  "drug_name" : "2 ML DUPILUMAB 150 MG\\/ML PREFILLED SYRINGE [DUPIXENT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1876916",
  "drug_name" : "DEUTETRABENAZINE 12 MG ORAL TABLET [AUSTEDO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1876920",
  "drug_name" : "DEUTETRABENAZINE 6 MG ORAL TABLET [AUSTEDO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1876924",
  "drug_name" : "DEUTETRABENAZINE 9 MG ORAL TABLET [AUSTEDO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1918042",
  "drug_name" : "ABIRATERONE ACETATE 500 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1918044",
  "drug_name" : "ABIRATERONE ACETATE 500 MG ORAL TABLET [ZYTIGA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1918230",
  "drug_name" : "VALBENAZINE 40 MG ORAL CAPSULE [INGREZZA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1918242",
  "drug_name" : "NIRAPARIB 100 MG ORAL CAPSULE [ZEJULA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1919094",
  "drug_name" : "MIDOSTAURIN 25 MG ORAL CAPSULE [RYDAPT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1919209",
  "drug_name" : "THIOTEPA 100 MG INJECTION [TEPADINA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1919512",
  "drug_name" : "2.4 ML DURVALUMAB 50 MG\\/ML INJECTION [IMFINZI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1919516",
  "drug_name" : "10 ML DURVALUMAB 50 MG\\/ML INJECTION [IMFINZI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1921010",
  "drug_name" : "0.1 ML ADALIMUMAB 100 MG\\/ML PREFILLED SYRINGE [HUMIRA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1921228",
  "drug_name" : "BRIGATINIB 30 MG ORAL TABLET [ALUNBRIG]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1921240",
  "drug_name" : "0.8 ML ADALIMUMAB 100 MG\\/ML AUTO-INJECTOR [HUMIRA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1921245",
  "drug_name" : "HUMIRA PEN 80 MG\\/0.8 ML - STARTER PACKAGE FOR CROHN'S DISEASE, ULCERATIVE COLITIS OR HIDRADENITIS SUPPURATIVA (3 COUNT)",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1921468",
  "drug_name" : "HUMIRA PEN 80 MG\\/0.8 ML AND 40 MG\\/0.4 ML - PSORIASIS\\/UVEITIS STARTER PACKAGE (3 COUNT)",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1921589",
  "drug_name" : "RUCAPARIB 250 MG ORAL TABLET [RUBRACA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1921598",
  "drug_name" : "METHOTREXATE 2.5 MG\\/ML ORAL SOLUTION [XATMEP]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1922512",
  "drug_name" : "TRASTUZUMAB 150 MG INJECTION [HERCEPTIN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1923054",
  "drug_name" : "KISQALI 200 MG - FEMARA 2.5 MG DAILY DOSE CARTON",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1923056",
  "drug_name" : "KISQALI 400 MG - FEMARA 2.5 MG DAILY DOSE CARTON",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1923058",
  "drug_name" : "KISQALI 600 MG - FEMARA 2.5 MG DAILY DOSE CARTON",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1923338",
  "drug_name" : "1.14 ML SARILUMAB 132 MG\\/ML PREFILLED SYRINGE [KEVZARA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1923347",
  "drug_name" : "1.14 ML SARILUMAB 175 MG\\/ML PREFILLED SYRINGE [KEVZARA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1923422",
  "drug_name" : "SOTALOL HYDROCHLORIDE 120 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1923424",
  "drug_name" : "SOTALOL HYDROCHLORIDE 160 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1923426",
  "drug_name" : "SOTALOL HYDROCHLORIDE 80 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1923428",
  "drug_name" : "TIMOLOL 2.5 MG\\/ML OPHTHALMIC SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1923432",
  "drug_name" : "DORZOLAMIDE 20 MG\\/ML \\/ TIMOLOL 5 MG\\/ML OPHTHALMIC SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1923822",
  "drug_name" : "DEFERASIROX 90 MG ORAL GRANULES",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1923826",
  "drug_name" : "DEFERASIROX 360 MG ORAL GRANULES",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1923828",
  "drug_name" : "DEFERASIROX 180 MG ORAL GRANULES",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1924315",
  "drug_name" : "RALTEGRAVIR 600 MG ORAL TABLET [ISENTRESS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1924316",
  "drug_name" : "100 ML EDARAVONE 0.3 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1924317",
  "drug_name" : "100 ML EDARAVONE 0.3 MG\\/ML INJECTION [RADICAVA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1925255",
  "drug_name" : "0.4 ML ABATACEPT 125 MG\\/ML PREFILLED SYRINGE [ORENCIA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1925257",
  "drug_name" : "0.7 ML ABATACEPT 125 MG\\/ML PREFILLED SYRINGE [ORENCIA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1925264",
  "drug_name" : "3.9 ML ARIPIPRAZOLE LAUROXIL 273 MG\\/ML PREFILLED SYRINGE [ARISTADA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1926069",
  "drug_name" : "RITONAVIR 100 MG ORAL POWDER [NORVIR]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1926823",
  "drug_name" : "C1 ESTERASE INHIBITOR (HUMAN) 2000 UNT INJECTION [HAEGARDA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1926827",
  "drug_name" : "C1 ESTERASE INHIBITOR (HUMAN) 3000 UNT INJECTION [HAEGARDA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1927890",
  "drug_name" : "11.7 ML HYALURONIDASE, HUMAN RECOMBINANT 2000 UNT\\/ML \\/ RITUXIMAB 120 MG\\/ML INJECTION [RITUXAN HYCELA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1927894",
  "drug_name" : "13.4 ML HYALURONIDASE, HUMAN RECOMBINANT 2000 UNT\\/ML \\/ RITUXIMAB 120 MG\\/ML INJECTION [RITUXAN HYCELA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1928569",
  "drug_name" : "15 ML DIBASIC POTASSIUM PHOSPHATE 236 MG\\/ML \\/ MONOBASIC POTASSIUM PHOSPHATE 224 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1928689",
  "drug_name" : "1 ML GUSELKUMAB 100 MG\\/ML PREFILLED SYRINGE [TREMFYA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1928941",
  "drug_name" : "GLUTAMINE 5000 MG POWDER FOR ORAL SOLUTION [ENDARI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1939299",
  "drug_name" : "1 ML BELIMUMAB 200 MG\\/ML AUTO-INJECTOR [BENLYSTA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1939335",
  "drug_name" : "SOFOSBUVIR 400 MG \\/ VELPATASVIR 100 MG \\/ VOXILAPREVIR 100 MG ORAL TABLET [VOSEVI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1939348",
  "drug_name" : "1 ML BELIMUMAB 200 MG\\/ML PREFILLED SYRINGE [BENLYSTA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1940372",
  "drug_name" : "ENASIDENIB 100 MG ORAL TABLET [IDHIFA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1940376",
  "drug_name" : "ENASIDENIB 50 MG ORAL TABLET [IDHIFA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1940654",
  "drug_name" : "NERATINIB 40 MG ORAL TABLET [NERLYNX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1940709",
  "drug_name" : "GLECAPREVIR 100 MG \\/ PIBRENTASVIR 40 MG ORAL TABLET [MAVYRET]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1942485",
  "drug_name" : "OLAPARIB 100 MG ORAL TABLET [LYNPARZA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1942489",
  "drug_name" : "OLAPARIB 150 MG ORAL TABLET [LYNPARZA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1942748",
  "drug_name" : "CYTARABINE LIPOSOME 100 MG \\/ DAUNORUBICIN LIPOSOMAL 44 MG INJECTION [VYXEOS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1942959",
  "drug_name" : "INOTUZUMAB OZOGAMICIN 0.9 MG INJECTION [BESPONSA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1944389",
  "drug_name" : "TRIPTORELIN 22.5 MG INJECTION [TRIPTODUR]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1944704",
  "drug_name" : "GEMTUZUMAB OZOGAMICIN 4.5 MG INJECTION [MYLOTARG]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1945086",
  "drug_name" : "COPANLISIB 60 MG INJECTION [ALIQOPA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1946520",
  "drug_name" : "3-MONTH 1.5 ML LEUPROLIDE ACETATE 20 MG\\/ML PREFILLED SYRINGE [LUPRON]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1946522",
  "drug_name" : "4-MONTH 1.5 ML LEUPROLIDE ACETATE 20 MG\\/ML PREFILLED SYRINGE [LUPRON]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1946772",
  "drug_name" : "METHOTREXATE 25 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1946836",
  "drug_name" : "ABEMACICLIB 50 MG ORAL TABLET [VERZENIO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1946840",
  "drug_name" : "ABEMACICLIB 100 MG ORAL TABLET [VERZENIO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1946844",
  "drug_name" : "ABEMACICLIB 150 MG ORAL TABLET [VERZENIO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1946848",
  "drug_name" : "ABEMACICLIB 200 MG ORAL TABLET [VERZENIO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197303",
  "drug_name" : "ACETAZOLAMIDE 125 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197304",
  "drug_name" : "ACETAZOLAMIDE 250 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197305",
  "drug_name" : "ACETIC ACID 20 MG\\/ML OTIC SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197310",
  "drug_name" : "ACYCLOVIR 200 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197311",
  "drug_name" : "ACYCLOVIR 400 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197313",
  "drug_name" : "ACYCLOVIR 800 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197316",
  "drug_name" : "ALBUTEROL 2 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197318",
  "drug_name" : "ALBUTEROL 4 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197319",
  "drug_name" : "ALLOPURINOL 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197320",
  "drug_name" : "ALLOPURINOL 300 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197321",
  "drug_name" : "ALPRAZOLAM 1 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197322",
  "drug_name" : "ALPRAZOLAM 2 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197351",
  "drug_name" : "6-AMINOCAPROIC ACID 500 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197361",
  "drug_name" : "AMLODIPINE 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197363",
  "drug_name" : "AMOXAPINE 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197364",
  "drug_name" : "AMOXAPINE 150 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197365",
  "drug_name" : "AMOXAPINE 25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197366",
  "drug_name" : "AMOXAPINE 50 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197379",
  "drug_name" : "ATENOLOL 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197380",
  "drug_name" : "ATENOLOL 25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197381",
  "drug_name" : "ATENOLOL 50 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197382",
  "drug_name" : "ATENOLOL 100 MG \\/ CHLORTHALIDONE 25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197383",
  "drug_name" : "ATENOLOL 50 MG \\/ CHLORTHALIDONE 25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197388",
  "drug_name" : "AZATHIOPRINE 50 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197391",
  "drug_name" : "BACLOFEN 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197392",
  "drug_name" : "BACLOFEN 20 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197405",
  "drug_name" : "BETAMETHASONE 0.0005 MG\\/MG TOPICAL OINTMENT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197407",
  "drug_name" : "BETAMETHASONE 1 MG\\/ML TOPICAL CREAM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197408",
  "drug_name" : "BETAMETHASONE 1 MG\\/ML TOPICAL LOTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197409",
  "drug_name" : "BETAMETHASONE 0.001 MG\\/MG TOPICAL OINTMENT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197411",
  "drug_name" : "BROMOCRIPTINE 2.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197412",
  "drug_name" : "BROMOCRIPTINE 5 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197417",
  "drug_name" : "BUMETANIDE 0.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197418",
  "drug_name" : "BUMETANIDE 1 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197419",
  "drug_name" : "BUMETANIDE 2 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197433",
  "drug_name" : "CALCIUM ACETATE 667 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197442",
  "drug_name" : "CARBAMAZEPINE 200 MG CHEWABLE TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197443",
  "drug_name" : "CARBIDOPA 10 MG \\/ LEVODOPA 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197444",
  "drug_name" : "CARBIDOPA 25 MG \\/ LEVODOPA 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197445",
  "drug_name" : "CARBIDOPA 25 MG \\/ LEVODOPA 250 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197448",
  "drug_name" : "LEVOCARNITINE 330 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197449",
  "drug_name" : "CEFACLOR 500 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197454",
  "drug_name" : "CEPHALEXIN 500 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197464",
  "drug_name" : "CLORAZEPATE DIPOTASSIUM 15 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197465",
  "drug_name" : "CLORAZEPATE DIPOTASSIUM 3.75 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197466",
  "drug_name" : "CLORAZEPATE DIPOTASSIUM 7.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197499",
  "drug_name" : "CHLORTHALIDONE 25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197500",
  "drug_name" : "CHLORTHALIDONE 50 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197511",
  "drug_name" : "CIPROFLOXACIN 250 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197512",
  "drug_name" : "CIPROFLOXACIN 750 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197516",
  "drug_name" : "CLARITHROMYCIN 250 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197517",
  "drug_name" : "CLARITHROMYCIN 500 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197518",
  "drug_name" : "CLINDAMYCIN 150 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197519",
  "drug_name" : "CLINDAMYCIN 10 MG\\/ML TOPICAL LOTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197527",
  "drug_name" : "CLONAZEPAM 0.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197528",
  "drug_name" : "CLONAZEPAM 1 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197529",
  "drug_name" : "CLONAZEPAM 2 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197535",
  "drug_name" : "CLOZAPINE 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197536",
  "drug_name" : "CLOZAPINE 25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197541",
  "drug_name" : "COLCHICINE 0.6 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197551",
  "drug_name" : "CYCLOSERINE 250 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197553",
  "drug_name" : "CYCLOSPORINE 25 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197554",
  "drug_name" : "DANAZOL 100 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197555",
  "drug_name" : "DANAZOL 200 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197556",
  "drug_name" : "DANAZOL 50 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197557",
  "drug_name" : "DAPSONE 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197558",
  "drug_name" : "DAPSONE 25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197572",
  "drug_name" : "DESONIDE 0.5 MG\\/ML TOPICAL LOTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197574",
  "drug_name" : "DESOXIMETASONE 2.5 MG\\/ML TOPICAL CREAM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197575",
  "drug_name" : "DESOXIMETASONE 0.0025 MG\\/MG TOPICAL OINTMENT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197577",
  "drug_name" : "DEXAMETHASONE 0.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197579",
  "drug_name" : "DEXAMETHASONE 1 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197580",
  "drug_name" : "DEXAMETHASONE 1.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197581",
  "drug_name" : "DEXAMETHASONE 2 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197582",
  "drug_name" : "DEXAMETHASONE 4 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197583",
  "drug_name" : "DEXAMETHASONE 6 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197589",
  "drug_name" : "DIAZEPAM 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197590",
  "drug_name" : "DIAZEPAM 2 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197591",
  "drug_name" : "DIAZEPAM 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197593",
  "drug_name" : "DIAZOXIDE 50 MG\\/ML ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197594",
  "drug_name" : "DICHLORPHENAMIDE 50 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197595",
  "drug_name" : "DICLOXACILLIN 250 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197596",
  "drug_name" : "DICLOXACILLIN 500 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197603",
  "drug_name" : "DIFLUNISAL 500 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197604",
  "drug_name" : "DIGOXIN 0.125 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197606",
  "drug_name" : "DIGOXIN 0.25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197622",
  "drug_name" : "DIPYRIDAMOLE 50 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197623",
  "drug_name" : "DISULFIRAM 250 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197624",
  "drug_name" : "DISULFIRAM 500 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197625",
  "drug_name" : "DOXAZOSIN 1 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197626",
  "drug_name" : "DOXAZOSIN 2 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197627",
  "drug_name" : "DOXAZOSIN 4 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197628",
  "drug_name" : "DOXAZOSIN 8 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197634",
  "drug_name" : "DRONABINOL 10 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197635",
  "drug_name" : "DRONABINOL 2.5 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197636",
  "drug_name" : "DRONABINOL 5 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197650",
  "drug_name" : "ERYTHROMYCIN 500 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197657",
  "drug_name" : "ESTRADIOL 0.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197658",
  "drug_name" : "ESTRADIOL 1 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197659",
  "drug_name" : "ESTRADIOL 2 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197682",
  "drug_name" : "ETHOSUXIMIDE 250 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197684",
  "drug_name" : "ETODOLAC 200 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197685",
  "drug_name" : "ETODOLAC 300 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197686",
  "drug_name" : "ETODOLAC 400 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197696",
  "drug_name" : "72 HR FENTANYL 0.075 MG\\/HR TRANSDERMAL SYSTEM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197698",
  "drug_name" : "FLUCONAZOLE 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197699",
  "drug_name" : "FLUCONAZOLE 150 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197700",
  "drug_name" : "FLUCONAZOLE 200 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197701",
  "drug_name" : "FLUCONAZOLE 50 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197702",
  "drug_name" : "FLUCYTOSINE 250 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197703",
  "drug_name" : "FLUCYTOSINE 500 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197726",
  "drug_name" : "FLUTAMIDE 125 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197730",
  "drug_name" : "FUROSEMIDE 10 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197731",
  "drug_name" : "FUROSEMIDE 8 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197732",
  "drug_name" : "FUROSEMIDE 80 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197735",
  "drug_name" : "GENTAMICIN 1 MG\\/ML TOPICAL CREAM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197736",
  "drug_name" : "50 ML GENTAMICIN 2 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197737",
  "drug_name" : "GLYBURIDE 1.25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197738",
  "drug_name" : "GLYCOPYRROLATE 1 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197739",
  "drug_name" : "GLYCOPYRROLATE 2 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197745",
  "drug_name" : "GUANFACINE 1 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197746",
  "drug_name" : "GUANFACINE 2 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197754",
  "drug_name" : "HALOPERIDOL 20 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197770",
  "drug_name" : "HYDROCHLOROTHIAZIDE 50 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197782",
  "drug_name" : "HYDROCORTISONE 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197783",
  "drug_name" : "HYDROCORTISONE 20 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197785",
  "drug_name" : "HYDROCORTISONE 25 MG\\/ML TOPICAL LOTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197787",
  "drug_name" : "HYDROCORTISONE 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197797",
  "drug_name" : "HYDROXYUREA 500 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197803",
  "drug_name" : "IBUPROFEN 20 MG\\/ML ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197805",
  "drug_name" : "IBUPROFEN 400 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197806",
  "drug_name" : "IBUPROFEN 600 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197807",
  "drug_name" : "IBUPROFEN 800 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197815",
  "drug_name" : "INDAPAMIDE 1.25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197816",
  "drug_name" : "INDAPAMIDE 2.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197817",
  "drug_name" : "INDOMETHACIN 25 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197818",
  "drug_name" : "INDOMETHACIN 50 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197832",
  "drug_name" : "ISONIAZID 300 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197839",
  "drug_name" : "ISOSORBIDE DINITRATE 30 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197844",
  "drug_name" : "ISOTRETINOIN 20 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197845",
  "drug_name" : "ISOTRETINOIN 40 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197853",
  "drug_name" : "KETOCONAZOLE 200 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197855",
  "drug_name" : "KETOPROFEN 50 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197860",
  "drug_name" : "LEUCOVORIN 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197862",
  "drug_name" : "LEUCOVORIN 25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197863",
  "drug_name" : "LEUCOVORIN 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197873",
  "drug_name" : "LEVORPHANOL TARTRATE 2 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197877",
  "drug_name" : "LIDOCAINE 25 MG\\/ML \\/ PRILOCAINE 25 MG\\/ML TOPICAL CREAM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197884",
  "drug_name" : "LISINOPRIL 40 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197885",
  "drug_name" : "HYDROCHLOROTHIAZIDE 12.5 MG \\/ LISINOPRIL 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197886",
  "drug_name" : "HYDROCHLOROTHIAZIDE 12.5 MG \\/ LISINOPRIL 20 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197887",
  "drug_name" : "HYDROCHLOROTHIAZIDE 25 MG \\/ LISINOPRIL 20 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197889",
  "drug_name" : "LITHIUM CARBONATE 300 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197890",
  "drug_name" : "LITHIUM CARBONATE 300 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197891",
  "drug_name" : "LITHIUM CARBONATE 300 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197892",
  "drug_name" : "LITHIUM CARBONATE 450 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197893",
  "drug_name" : "LITHIUM CARBONATE 600 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197900",
  "drug_name" : "LORAZEPAM 0.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197901",
  "drug_name" : "LORAZEPAM 1 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197902",
  "drug_name" : "LORAZEPAM 2 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197903",
  "drug_name" : "LOVASTATIN 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197904",
  "drug_name" : "LOVASTATIN 20 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197905",
  "drug_name" : "LOVASTATIN 40 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197931",
  "drug_name" : "MERCAPTOPURINE 50 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197939",
  "drug_name" : "METHAZOLAMIDE 25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197940",
  "drug_name" : "METHAZOLAMIDE 50 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197941",
  "drug_name" : "METHIMAZOLE 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197942",
  "drug_name" : "METHIMAZOLE 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197943",
  "drug_name" : "METHOCARBAMOL 500 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197944",
  "drug_name" : "METHOCARBAMOL 750 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197958",
  "drug_name" : "METHYLDOPA 500 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197971",
  "drug_name" : "METHYLPREDNISOLONE 32 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197973",
  "drug_name" : "METHYLPREDNISOLONE 8 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197975",
  "drug_name" : "METHYLTESTOSTERONE 10 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197978",
  "drug_name" : "METOLAZONE 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197979",
  "drug_name" : "METOLAZONE 2.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197980",
  "drug_name" : "METYROSINE 250 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197984",
  "drug_name" : "MINOCYCLINE 100 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197985",
  "drug_name" : "MINOCYCLINE 50 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197986",
  "drug_name" : "MINOXIDIL 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197987",
  "drug_name" : "MINOXIDIL 2.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "197989",
  "drug_name" : "MITOXANTRONE 2 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198006",
  "drug_name" : "NADOLOL 20 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198007",
  "drug_name" : "NADOLOL 40 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198008",
  "drug_name" : "NADOLOL 80 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198012",
  "drug_name" : "NAPROXEN 375 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198013",
  "drug_name" : "NAPROXEN 250 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198014",
  "drug_name" : "NAPROXEN 500 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198031",
  "drug_name" : "24 HR NICOTINE 0.292 MG\\/HR TRANSDERMAL SYSTEM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198032",
  "drug_name" : "NIFEDIPINE 10 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198033",
  "drug_name" : "NIFEDIPINE 20 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198034",
  "drug_name" : "24 HR NIFEDIPINE 30 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198035",
  "drug_name" : "24 HR NIFEDIPINE 60 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198036",
  "drug_name" : "24 HR NIFEDIPINE 90 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198037",
  "drug_name" : "NIMODIPINE 30 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198038",
  "drug_name" : "NITROGLYCERIN 0.3 MG SUBLINGUAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198039",
  "drug_name" : "NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198040",
  "drug_name" : "NITROGLYCERIN 0.6 MG SUBLINGUAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198045",
  "drug_name" : "NORTRIPTYLINE 10 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198046",
  "drug_name" : "NORTRIPTYLINE 50 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198047",
  "drug_name" : "NORTRIPTYLINE 75 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198051",
  "drug_name" : "OMEPRAZOLE 20 MG DELAYED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198052",
  "drug_name" : "ONDANSETRON 4 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198057",
  "drug_name" : "OXAZEPAM 10 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198059",
  "drug_name" : "OXAZEPAM 30 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198070",
  "drug_name" : "PENICILLAMINE 250 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198071",
  "drug_name" : "PENICILLAMINE 250 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198075",
  "drug_name" : "PERPHENAZINE 16 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198076",
  "drug_name" : "PERPHENAZINE 2 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198077",
  "drug_name" : "PERPHENAZINE 4 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198078",
  "drug_name" : "PERPHENAZINE 8 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198083",
  "drug_name" : "PHENOBARBITAL 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198086",
  "drug_name" : "PHENOBARBITAL 16.2 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198089",
  "drug_name" : "PHENOBARBITAL 60 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198103",
  "drug_name" : "PIMOZIDE 2 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198107",
  "drug_name" : "PIROXICAM 10 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198108",
  "drug_name" : "PIROXICAM 20 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198116",
  "drug_name" : "POTASSIUM CHLORIDE 20 MEQ EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198140",
  "drug_name" : "PRAZIQUANTEL 600 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198141",
  "drug_name" : "PRAZOSIN 5 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198142",
  "drug_name" : "PREDNISOLONE 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198144",
  "drug_name" : "PREDNISONE 1 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198145",
  "drug_name" : "PREDNISONE 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198146",
  "drug_name" : "PREDNISONE 2.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198148",
  "drug_name" : "PREDNISONE 50 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198150",
  "drug_name" : "PRIMIDONE 50 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198152",
  "drug_name" : "PROBENECID 500 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198153",
  "drug_name" : "COLCHICINE 0.5 MG \\/ PROBENECID 500 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198159",
  "drug_name" : "PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198175",
  "drug_name" : "PROPYLTHIOURACIL 50 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198181",
  "drug_name" : "PYRAZINAMIDE 500 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198182",
  "drug_name" : "PYRIMETHAMINE 25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198188",
  "drug_name" : "RAMIPRIL 2.5 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198189",
  "drug_name" : "RAMIPRIL 5 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198200",
  "drug_name" : "RIFABUTIN 150 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198201",
  "drug_name" : "RIFAMPIN 150 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198202",
  "drug_name" : "RIFAMPIN 300 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198211",
  "drug_name" : "SIMVASTATIN 40 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198215",
  "drug_name" : "SODIUM FLUORIDE 0.55 MG CHEWABLE TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198222",
  "drug_name" : "SPIRONOLACTONE 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198223",
  "drug_name" : "SPIRONOLACTONE 50 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198224",
  "drug_name" : "HYDROCHLOROTHIAZIDE 25 MG \\/ SPIRONOLACTONE 25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198228",
  "drug_name" : "SULFADIAZINE 500 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198232",
  "drug_name" : "SULFASALAZINE 500 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198238",
  "drug_name" : "SULINDAC 150 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198239",
  "drug_name" : "SULINDAC 200 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198240",
  "drug_name" : "TAMOXIFEN 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198241",
  "drug_name" : "TEMAZEPAM 15 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198242",
  "drug_name" : "TEMAZEPAM 30 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198243",
  "drug_name" : "TEMAZEPAM 7.5 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198245",
  "drug_name" : "TERCONAZOLE 80 MG VAGINAL INSERT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198250",
  "drug_name" : "TETRACYCLINE HYDROCHLORIDE 250 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198252",
  "drug_name" : "TETRACYCLINE HYDROCHLORIDE 500 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198270",
  "drug_name" : "THIORIDAZINE 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198274",
  "drug_name" : "THIORIDAZINE 25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198275",
  "drug_name" : "THIORIDAZINE 50 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198284",
  "drug_name" : "TIMOLOL 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198287",
  "drug_name" : "TIOPRONIN 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198297",
  "drug_name" : "TOLMETIN 600 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198300",
  "drug_name" : "TRETINOIN 1 MG\\/ML TOPICAL CREAM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198312",
  "drug_name" : "TRIAMTERENE 100 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198313",
  "drug_name" : "TRIAMTERENE 50 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198316",
  "drug_name" : "HYDROCHLOROTHIAZIDE 25 MG \\/ TRIAMTERENE 37.5 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198317",
  "drug_name" : "TRIAZOLAM 0.125 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198318",
  "drug_name" : "TRIAZOLAM 0.25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198322",
  "drug_name" : "TRIFLUOPERAZINE 1 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198323",
  "drug_name" : "TRIFLUOPERAZINE 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198324",
  "drug_name" : "TRIFLUOPERAZINE 2 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198325",
  "drug_name" : "TRIFLUOPERAZINE 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198332",
  "drug_name" : "TRIMETHOPRIM 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198334",
  "drug_name" : "SULFAMETHOXAZOLE 400 MG \\/ TRIMETHOPRIM 80 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198335",
  "drug_name" : "SULFAMETHOXAZOLE 800 MG \\/ TRIMETHOPRIM 160 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198352",
  "drug_name" : "ZIDOVUDINE 100 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198358",
  "drug_name" : "FELBAMATE 400 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198359",
  "drug_name" : "FELBAMATE 600 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198365",
  "drug_name" : "PROCHLORPERAZINE 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198369",
  "drug_name" : "TORSEMIDE 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198370",
  "drug_name" : "TORSEMIDE 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198371",
  "drug_name" : "TORSEMIDE 20 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198372",
  "drug_name" : "TORSEMIDE 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198373",
  "drug_name" : "CALCIPOTRIENE 0.00005 MG\\/MG TOPICAL OINTMENT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198377",
  "drug_name" : "TACROLIMUS 1 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198378",
  "drug_name" : "TACROLIMUS 5 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198382",
  "drug_name" : "FAMCICLOVIR 500 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198427",
  "drug_name" : "LAMOTRIGINE 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198428",
  "drug_name" : "LAMOTRIGINE 150 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198429",
  "drug_name" : "LAMOTRIGINE 200 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "198430",
  "drug_name" : "LAMOTRIGINE 25 MG DISINTEGRATING ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1986331",
  "drug_name" : "VALBENAZINE 80 MG ORAL CAPSULE [INGREZZA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1986819",
  "drug_name" : "ACALABRUTINIB 100 MG ORAL CAPSULE [CALQUENCE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1986830",
  "drug_name" : "0.5 ML VARICELLA ZOSTER VIRUS GLYCOPROTEIN E, RECOMBINANT 0.1 MG\\/ML INJECTION [SHINGRIX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1987734",
  "drug_name" : "BOSUTINIB 400 MG ORAL TABLET [BOSULIF]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1988657",
  "drug_name" : "12 ML LETERMOVIR 20 MG\\/ML INJECTION [PREVYMIS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1988661",
  "drug_name" : "24 ML LETERMOVIR 20 MG\\/ML INJECTION [PREVYMIS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1988671",
  "drug_name" : "LETERMOVIR 240 MG ORAL TABLET [PREVYMIS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1988675",
  "drug_name" : "LETERMOVIR 480 MG ORAL TABLET [PREVYMIS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1988768",
  "drug_name" : "BRIGATINIB 90 MG ORAL TABLET [ALUNBRIG]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1988772",
  "drug_name" : "BRIGATINIB 180 MG ORAL TABLET [ALUNBRIG]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1988786",
  "drug_name" : "ALUNBRIG INITIATION PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1989081",
  "drug_name" : "BOSENTAN 32 MG TABLET FOR ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1989085",
  "drug_name" : "BOSENTAN 32 MG TABLET FOR ORAL SUSPENSION [TRACLEER]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1989109",
  "drug_name" : "1 ML BENRALIZUMAB 30 MG\\/ML PREFILLED SYRINGE [FASENRA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1989506",
  "drug_name" : "DOLUTEGRAVIR 50 MG \\/ RILPIVIRINE 25 MG ORAL TABLET [JULUCA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "199055",
  "drug_name" : "METRONIDAZOLE 375 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "199058",
  "drug_name" : "MYCOPHENOLATE MOFETIL 250 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "199119",
  "drug_name" : "OMEPRAZOLE 10 MG DELAYED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "199123",
  "drug_name" : "BICALUTAMIDE 50 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1991311",
  "drug_name" : "0.25 MG, 0.5 MG DOSE 1.5 ML SEMAGLUTIDE 1.34 MG\\/ML PEN INJECTOR [OZEMPIC]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1991329",
  "drug_name" : "NDA201739 0.1 ML EPINEPHRINE 1 MG\\/ML AUTO-INJECTOR [AUVI-Q]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1991413",
  "drug_name" : "24 ML NIVOLUMAB 10 MG\\/ML INJECTION [OPDIVO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "199148",
  "drug_name" : "LAMIVUDINE 10 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "199149",
  "drug_name" : "ACARBOSE 50 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "199150",
  "drug_name" : "ACARBOSE 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "199159",
  "drug_name" : "TRETINOIN 10 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "199164",
  "drug_name" : "PHENOBARBITAL 97.2 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "199167",
  "drug_name" : "PHENOBARBITAL 32.4 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "199168",
  "drug_name" : "PHENOBARBITAL 64.8 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "199192",
  "drug_name" : "FAMCICLOVIR 125 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "199193",
  "drug_name" : "FAMCICLOVIR 250 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "199206",
  "drug_name" : "RILUZOLE 50 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "199224",
  "drug_name" : "ANASTROZOLE 1 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1992281",
  "drug_name" : "EMOLLIENT CLOBETASOL PROPIONATE 0.5 MG\\/ML TOPICAL CREAM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1992303",
  "drug_name" : "12 HR TIMOLOL 5 MG\\/ML OPHTHALMIC SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "199245",
  "drug_name" : "GLIMEPIRIDE 1 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "199246",
  "drug_name" : "GLIMEPIRIDE 2 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "199247",
  "drug_name" : "GLIMEPIRIDE 4 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1992545",
  "drug_name" : "6 ML ARSENIC TRIOXIDE 2 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1992571",
  "drug_name" : "GLYCOPYRROLATE 0.025 MG\\/ML INHALATION SOLUTION [LONHALA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "199369",
  "drug_name" : "SODIUM PHENYLBUTYRATE 500 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "199370",
  "drug_name" : "CIPROFLOXACIN 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "199376",
  "drug_name" : "POTASSIUM CITRATE 5 MEQ EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "199378",
  "drug_name" : "12 HR CARBAMAZEPINE 100 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "199381",
  "drug_name" : "POTASSIUM CITRATE 10 MEQ EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "199387",
  "drug_name" : "RISPERIDONE 1 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "199388",
  "drug_name" : "5 ML CIDOFOVIR 75 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "199390",
  "drug_name" : "ETODOLAC 500 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "199422",
  "drug_name" : "NEVIRAPINE 200 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1994362",
  "drug_name" : "IBRUTINIB 70 MG ORAL CAPSULE [IMBRUVICA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "199450",
  "drug_name" : "CLOBAZAM 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "199521",
  "drug_name" : "VIGABATRIN 500 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1995479",
  "drug_name" : "AMYLASE 168000 UNT \\/ LIPASE 40000 UNT \\/ PROTEASE 126000 UNT DELAYED RELEASE ORAL CAPSULE [ZENPEP]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "199592",
  "drug_name" : "TETRABENAZINE 25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1996189",
  "drug_name" : "0.5 ML BUPRENORPHINE 200 MG\\/ML PREFILLED SYRINGE [SUBLOCADE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1996193",
  "drug_name" : "1.5 ML BUPRENORPHINE 200 MG\\/ML PREFILLED SYRINGE [SUBLOCADE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1996246",
  "drug_name" : "DAPTOMYCIN 350 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "199663",
  "drug_name" : "ZIDOVUDINE 300 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "199672",
  "drug_name" : "ALBENDAZOLE 200 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "199689",
  "drug_name" : "ACITRETIN 10 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "199690",
  "drug_name" : "ACITRETIN 25 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "199703",
  "drug_name" : "CABERGOLINE 0.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "199739",
  "drug_name" : "50 ML FAMOTIDINE 0.4 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1998453",
  "drug_name" : "SENSOR ARIPIPRAZOLE 10 MG ORAL TABLET [ABILIFY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1998455",
  "drug_name" : "SENSOR ARIPIPRAZOLE 15 MG ORAL TABLET [ABILIFY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1998457",
  "drug_name" : "SENSOR ARIPIPRAZOLE 2 MG ORAL TABLET [ABILIFY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1998459",
  "drug_name" : "SENSOR ARIPIPRAZOLE 20 MG ORAL TABLET [ABILIFY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1998461",
  "drug_name" : "SENSOR ARIPIPRAZOLE 30 MG ORAL TABLET [ABILIFY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1998463",
  "drug_name" : "SENSOR ARIPIPRAZOLE 5 MG ORAL TABLET [ABILIFY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1998631",
  "drug_name" : "AMERICAN HOUSE DUST MITE ALLERGENIC EXTRACT 6 SQ-HDM \\/ EUROPEAN HOUSE DUST MITE ALLERGENIC EXTRACT 6 SQ-HDM SUBLINGUAL TABLET [ODACTRA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "199884",
  "drug_name" : "LEVOFLOXACIN 250 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "199885",
  "drug_name" : "LEVOFLOXACIN 500 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "199888",
  "drug_name" : "TOPIRAMATE 25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "199889",
  "drug_name" : "TOPIRAMATE 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "199890",
  "drug_name" : "TOPIRAMATE 200 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "199903",
  "drug_name" : "HYDROCHLOROTHIAZIDE 12.5 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1999316",
  "drug_name" : "HYDROXYUREA 1000 MG ORAL TABLET [SIKLOS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1999389",
  "drug_name" : "SYMDEKO 100 MG \\/ 150 MG AND 150 MG PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1999531",
  "drug_name" : "10 ML GANCICLOVIR 50 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1999587",
  "drug_name" : "APALUTAMIDE 60 MG ORAL TABLET [ERLEADA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "1999673",
  "drug_name" : "BICTEGRAVIR 50 MG \\/ EMTRICITABINE 200 MG \\/ TENOFOVIR ALAFENAMIDE 25 MG ORAL TABLET [BIKTARVY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2000007",
  "drug_name" : "1 ML GLATIRAMER ACETATE 40 MG\\/ML PREFILLED SYRINGE [GLATOPA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2000019",
  "drug_name" : "IBRUTINIB 140 MG ORAL TABLET [IMBRUVICA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2000023",
  "drug_name" : "IBRUTINIB 280 MG ORAL TABLET [IMBRUVICA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2000027",
  "drug_name" : "IBRUTINIB 420 MG ORAL TABLET [IMBRUVICA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2000031",
  "drug_name" : "IBRUTINIB 560 MG ORAL TABLET [IMBRUVICA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2000134",
  "drug_name" : "VANCOMYCIN 50 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "200031",
  "drug_name" : "CARVEDILOL 6.25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "200032",
  "drug_name" : "CARVEDILOL 12.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "200033",
  "drug_name" : "CARVEDILOL 25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "200034",
  "drug_name" : "OLANZAPINE 2.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "200060",
  "drug_name" : "MYCOPHENOLATE MOFETIL 500 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "200064",
  "drug_name" : "LETROZOLE 2.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2000695",
  "drug_name" : "KELNOR 1\\/50 28 DAY PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "200082",
  "drug_name" : "LAMIVUDINE 150 MG \\/ ZIDOVUDINE 300 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "200094",
  "drug_name" : "IRBESARTAN 75 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "200095",
  "drug_name" : "IRBESARTAN 150 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "200096",
  "drug_name" : "IRBESARTAN 300 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2001100",
  "drug_name" : "DOXORUBICIN HYDROCHLORIDE 50 MG INJECTION [ADRIAMYCIN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "200131",
  "drug_name" : "12 HR CARBAMAZEPINE 300 MG EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2001319",
  "drug_name" : "ROFLUMILAST 0.25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "200132",
  "drug_name" : "ACARBOSE 25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "200133",
  "drug_name" : "12 HR CARBAMAZEPINE 200 MG EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2001424",
  "drug_name" : "EFAVIRENZ 400 MG \\/ LAMIVUDINE 300 MG \\/ TENOFOVIR DISOPROXIL FUMARATE 300 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2001430",
  "drug_name" : "EFAVIRENZ 400 MG \\/ LAMIVUDINE 300 MG \\/ TENOFOVIR DISOPROXIL FUMARATE 300 MG ORAL TABLET [SYMFI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2001506",
  "drug_name" : "LAMOTRIGINE 150 MG ORAL TABLET [SUBVENITE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2001508",
  "drug_name" : "LAMOTRIGINE 25 MG ORAL TABLET [SUBVENITE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "200193",
  "drug_name" : "ZOLMITRIPTAN 2.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "200194",
  "drug_name" : "ZOLMITRIPTAN 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "200220",
  "drug_name" : "TOLCAPONE 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "200224",
  "drug_name" : "MONTELUKAST 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "200256",
  "drug_name" : "REPAGLINIDE 1 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "200257",
  "drug_name" : "REPAGLINIDE 0.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "200258",
  "drug_name" : "REPAGLINIDE 2 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2002717",
  "drug_name" : "NILOTINIB 50 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "200284",
  "drug_name" : "HYDROCHLOROTHIAZIDE 12.5 MG \\/ VALSARTAN 80 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "200285",
  "drug_name" : "HYDROCHLOROTHIAZIDE 12.5 MG \\/ VALSARTAN 160 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2003255",
  "drug_name" : "LAMIVUDINE 300 MG \\/ TENOFOVIR DISOPROXIL FUMARATE 300 MG ORAL TABLET [CIMDUO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "200329",
  "drug_name" : "OMEPRAZOLE 40 MG DELAYED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "200345",
  "drug_name" : "SIMVASTATIN 80 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "200346",
  "drug_name" : "CEFDINIR 300 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "200371",
  "drug_name" : "CITALOPRAM 20 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2003767",
  "drug_name" : "1.14 ML SARILUMAB 175 MG\\/ML AUTO-INJECTOR [KEVZARA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2003796",
  "drug_name" : "LAMOTRIGINE 100 MG ORAL TABLET [SUBVENITE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2003797",
  "drug_name" : "SUBVENITE GREEN KIT (FOR PATIENTS TAKING CARBAMAZEPINE, PHENYTOIN, PHENOBARBITAL, OR PRIMIDONE AND NOT TAKING VALPROATE)",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2003798",
  "drug_name" : "SUBVENITE ORANGE KIT (FOR PATIENTS NOT TAKING CARBAMAZEPINE, PHENYTOIN, PHENOBARBITAL, PRIMIDONE, OR VALPROATE)",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2003799",
  "drug_name" : "SUBVENITE BLUE KIT (FOR PATIENTS TAKING VALPROATE)",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2003801",
  "drug_name" : "LAMOTRIGINE 200 MG ORAL TABLET [SUBVENITE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "201185",
  "drug_name" : "MAFENIDE 85 MG\\/ML TOPICAL CREAM [SULFAMYLON]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "201708",
  "drug_name" : "ISOCARBOXAZID 10 MG ORAL TABLET [MARPLAN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "203088",
  "drug_name" : "KETOCONAZOLE 20 MG\\/ML TOPICAL CREAM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "204119",
  "drug_name" : "MALATHION 5 MG\\/ML TOPICAL LOTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "204135",
  "drug_name" : "DESONIDE 0.0005 MG\\/MG TOPICAL OINTMENT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2043464",
  "drug_name" : "EFAVIRENZ 600 MG \\/ LAMIVUDINE 300 MG \\/ TENOFOVIR DISOPROXIL FUMARATE 300 MG ORAL TABLET [SYMFI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2043864",
  "drug_name" : "1 ML BUROSUMAB-TWZA 10 MG\\/ML INJECTION [CRYSVITA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2043870",
  "drug_name" : "1 ML BUROSUMAB-TWZA 20 MG\\/ML INJECTION [CRYSVITA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2043878",
  "drug_name" : "1 ML BUROSUMAB-TWZA 30 MG\\/ML INJECTION [CRYSVITA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "204416",
  "drug_name" : "HALOPERIDOL 5 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "204423",
  "drug_name" : "HYDROCORTISONE 10 MG\\/ML \\/ NEOMYCIN 3.5 MG\\/ML \\/ POLYMYXIN B 10000 UNT\\/ML OTIC SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "204430",
  "drug_name" : "ISONIAZID 100 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "204441",
  "drug_name" : "FAMOTIDINE 10 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "204466",
  "drug_name" : "50 ML PENICILLIN G POTASSIUM 40000 UNT\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2044928",
  "drug_name" : "FOSTAMATINIB 100 MG ORAL TABLET [TAVALISSE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2044932",
  "drug_name" : "FOSTAMATINIB 150 MG ORAL TABLET [TAVALISSE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "204508",
  "drug_name" : "FLUMAZENIL 0.1 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "204520",
  "drug_name" : "POTASSIUM CHLORIDE 2 MEQ\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2045493",
  "drug_name" : "FINGOLIMOD 0.25 MG ORAL CAPSULE [GILENYA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2045502",
  "drug_name" : "0.05 ML RANIBIZUMAB 6 MG\\/ML PREFILLED SYRINGE [LUCENTIS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2045958",
  "drug_name" : "AVATROMBOPAG 20 MG ORAL TABLET [DOPTELET]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2045959",
  "drug_name" : "DOPTELET 40 MG DAILY DOSE CARTON PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2045961",
  "drug_name" : "DOPTELET 60 MG DAILY DOSE CARTON PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2046145",
  "drug_name" : "16 ML BEVACIZUMAB-AWWB 25 MG\\/ML INJECTION [MVASI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2046149",
  "drug_name" : "4 ML BEVACIZUMAB-AWWB 25 MG\\/ML INJECTION [MVASI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2046370",
  "drug_name" : "0.5 ML PEGVALIASE-PQPZ 20 MG\\/ML PREFILLED SYRINGE [PALYNZIQ]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2046376",
  "drug_name" : "0.5 ML PEGVALIASE-PQPZ 5 MG\\/ML PREFILLED SYRINGE [PALYNZIQ]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2046380",
  "drug_name" : "1 ML PEGVALIASE-PQPZ 20 MG\\/ML PREFILLED SYRINGE [PALYNZIQ]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2046585",
  "drug_name" : "ABIRATERONE ACETATE 125 MG ORAL TABLET [YONSA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2046591",
  "drug_name" : "LOFEXIDINE 0.18 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2046644",
  "drug_name" : "CARFILZOMIB 10 MG INJECTION [KYPROLIS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2047247",
  "drug_name" : "BARICITINIB 2 MG ORAL TABLET [OLUMIANT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2047639",
  "drug_name" : "SODIUM ZIRCONIUM CYCLOSILICATE 5000 MG POWDER FOR ORAL SUSPENSION [LOKELMA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2047646",
  "drug_name" : "HALOBETASOL PROPIONATE 0.5 MG\\/ML TOPICAL FOAM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2047882",
  "drug_name" : "1 ML TESTOSTERONE CYPIONATE 200 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2048025",
  "drug_name" : "0.6 ML PEGFILGRASTIM-JMDB 10 MG\\/ML PREFILLED SYRINGE [FULPHILA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "204844",
  "drug_name" : "AZITHROMYCIN 600 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2048568",
  "drug_name" : "TOFACITINIB 10 MG ORAL TABLET [XELJANZ]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "204870",
  "drug_name" : "MESNA 100 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "204874",
  "drug_name" : "HYDROCORTISONE 10 MG\\/ML \\/ NEOMYCIN 3.5 MG\\/ML \\/ POLYMYXIN B 10000 UNT\\/ML OPHTHALMIC SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2049121",
  "drug_name" : "ENCORAFENIB 75 MG ORAL CAPSULE [BRAFTOVI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2049133",
  "drug_name" : "BINIMETINIB 15 MG ORAL TABLET [MEKTOVI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2049271",
  "drug_name" : "PIMAVANSERIN 10 MG ORAL TABLET [NUPLAZID]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2049278",
  "drug_name" : "PIMAVANSERIN 34 MG ORAL CAPSULE [NUPLAZID]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2049343",
  "drug_name" : "2.4 ML ARIPIPRAZOLE LAUROXIL 281.3 MG\\/ML PREFILLED SYRINGE [ARISTADA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2049603",
  "drug_name" : "CROTAMITON 100 MG\\/ML TOPICAL LOTION [CROTAN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "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" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2049732",
  "drug_name" : "PASIREOTIDE 30 MG INJECTION [SIGNIFOR]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2049736",
  "drug_name" : "PASIREOTIDE 10 MG INJECTION [SIGNIFOR]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2049858",
  "drug_name" : "ELAGOLIX 150 MG ORAL TABLET [ORILISSA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2049862",
  "drug_name" : "ELAGOLIX 200 MG ORAL TABLET [ORILISSA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2049884",
  "drug_name" : "IVOSIDENIB 250 MG ORAL TABLET [TIBSOVO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "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" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "205175",
  "drug_name" : "5 ML CYCLOSPORINE 50 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2052609",
  "drug_name" : "TACROLIMUS 0.2 MG GRANULES FOR ORAL SUSPENSION [PROGRAF]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2052704",
  "drug_name" : "TACROLIMUS 1 MG GRANULES FOR ORAL SUSPENSION [PROGRAF]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "205284",
  "drug_name" : "LEFLUNOMIDE 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "205285",
  "drug_name" : "LEFLUNOMIDE 20 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "205290",
  "drug_name" : "EFAVIRENZ 200 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "205292",
  "drug_name" : "EFAVIRENZ 50 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "205301",
  "drug_name" : "PREDNISONE 5 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "205315",
  "drug_name" : "TOPIRAMATE 25 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "205316",
  "drug_name" : "TOPIRAMATE 15 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "205322",
  "drug_name" : "CELECOXIB 100 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "205323",
  "drug_name" : "CELECOXIB 200 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "205324",
  "drug_name" : "MODAFINIL 200 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "205326",
  "drug_name" : "LISINOPRIL 30 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "205328",
  "drug_name" : "LAMIVUDINE 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2053512",
  "drug_name" : "IVACAFTOR 125 MG \\/ LUMACAFTOR 100 MG ORAL GRANULES [ORKAMBI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2053519",
  "drug_name" : "IVACAFTOR 188 MG \\/ LUMACAFTOR 150 MG ORAL GRANULES [ORKAMBI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2053529",
  "drug_name" : "5 ML PATISIRAN LIPID COMPLEX 2 MG\\/ML INJECTION [ONPATTRO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2053927",
  "drug_name" : "SODIUM ZIRCONIUM CYCLOSILICATE 10000 MG POWDER FOR ORAL SUSPENSION [LOKELMA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2054086",
  "drug_name" : "5 ML MOGAMULIZUMAB-KPKC 4 MG\\/ML INJECTION [POTELIGEO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2054157",
  "drug_name" : "LENVIMA 4 MG (AS LENVATINIB MESYLATE) DAILY DOSE 30 DAY SUPPLY PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2054159",
  "drug_name" : "LENVIMA 12 MG (AS LENVATINIB MESYLATE) DAILY DOSE 30 DAY SUPPLY PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2054269",
  "drug_name" : "INGREZZA 40 MG \\/ 80 MG STARTER PACK, 28 CAPSULES",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2054275",
  "drug_name" : "GALAFOLD 123 MG 28 DAY (4 WEEK) WALLET PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2054979",
  "drug_name" : "STIRIPENTOL 250 MG ORAL CAPSULE [DIACOMIT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2054983",
  "drug_name" : "STIRIPENTOL 500 MG ORAL CAPSULE [DIACOMIT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2055014",
  "drug_name" : "STIRIPENTOL 500 MG POWDER FOR ORAL SUSPENSION [DIACOMIT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2055016",
  "drug_name" : "STIRIPENTOL 250 MG POWDER FOR ORAL SUSPENSION [DIACOMIT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2055026",
  "drug_name" : "CYCLOSPORINE 0.9 MG\\/ML OPHTHALMIC SOLUTION [CEQUA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "205532",
  "drug_name" : "DORNASE ALFA 1 MG\\/ML INHALATION SOLUTION [PULMOZYME]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "205562",
  "drug_name" : "ESTRAMUSTINE 140 MG ORAL CAPSULE [EMCYT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2055650",
  "drug_name" : "2 ML LANADELUMAB-FLYO 150 MG\\/ML INJECTION [TAKHZYRO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2055672",
  "drug_name" : "0.8 ML RISPERIDONE 150 MG\\/ML PREFILLED SYRINGE [PERSERIS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2055676",
  "drug_name" : "0.6 ML RISPERIDONE 150 MG\\/ML PREFILLED SYRINGE [PERSERIS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2055766",
  "drug_name" : "DORAVIRINE 100 MG ORAL TABLET [PIFELTRO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2055815",
  "drug_name" : "DORAVIRINE 100 MG \\/ LAMIVUDINE 300 MG \\/ TENOFOVIR DISOPROXIL FUMARATE 300 MG ORAL TABLET [DELSTRIGO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "205646",
  "drug_name" : "FLUTAMIDE 125 MG ORAL CAPSULE [EULEXIN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2056700",
  "drug_name" : "1.5 ML FREMANEZUMAB-VFRM 150 MG\\/ML PREFILLED SYRINGE [AJOVY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2056895",
  "drug_name" : "EVEROLIMUS 1 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2057205",
  "drug_name" : "0.5 ML FILGRASTIM-AAFI 0.6 MG\\/ML PREFILLED SYRINGE [NIVESTYM]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2057212",
  "drug_name" : "1 ML FILGRASTIM-AAFI 0.3 MG\\/ML INJECTION [NIVESTYM]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2057216",
  "drug_name" : "0.8 ML FILGRASTIM-AAFI 0.6 MG\\/ML PREFILLED SYRINGE [NIVESTYM]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2057219",
  "drug_name" : "1.6 ML FILGRASTIM-AAFI 0.3 MG\\/ML INJECTION [NIVESTYM]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "205739",
  "drug_name" : "ECHOTHIOPHATE IODIDE 1.25 MG\\/ML OPHTHALMIC SOLUTION [PHOSPHOLINE IODIDE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2058520",
  "drug_name" : "DUVELISIB 15 MG ORAL CAPSULE [COPIKTRA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2058525",
  "drug_name" : "DUVELISIB 25 MG ORAL CAPSULE [COPIKTRA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2058835",
  "drug_name" : "7 ML CEMIPLIMAB-RWLC 50 MG\\/ML INJECTION [LIBTAYO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2058845",
  "drug_name" : "LEVORPHANOL TARTRATE 3 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2058863",
  "drug_name" : "120 ML GEMCITABINE 10 MG\\/ML INJECTION [INFUGEM]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2058867",
  "drug_name" : "140 ML GEMCITABINE 10 MG\\/ML INJECTION [INFUGEM]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2058881",
  "drug_name" : "150 ML GEMCITABINE 10 MG\\/ML INJECTION [INFUGEM]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2058883",
  "drug_name" : "160 ML GEMCITABINE 10 MG\\/ML INJECTION [INFUGEM]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2058891",
  "drug_name" : "170 ML GEMCITABINE 10 MG\\/ML INJECTION [INFUGEM]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2058893",
  "drug_name" : "180 ML GEMCITABINE 10 MG\\/ML INJECTION [INFUGEM]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2058895",
  "drug_name" : "190 ML GEMCITABINE 10 MG\\/ML INJECTION [INFUGEM]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2058906",
  "drug_name" : "CANNABIDIOL 100 MG\\/ML ORAL SOLUTION [EPIDIOLEX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2058918",
  "drug_name" : "130 ML GEMCITABINE 10 MG\\/ML INJECTION [INFUGEM]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2058922",
  "drug_name" : "DACOMITINIB 15 MG ORAL TABLET [VIZIMPRO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2058926",
  "drug_name" : "DACOMITINIB 30 MG ORAL TABLET [VIZIMPRO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2058928",
  "drug_name" : "200 ML GEMCITABINE 10 MG\\/ML INJECTION [INFUGEM]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2058932",
  "drug_name" : "DACOMITINIB 45 MG ORAL TABLET [VIZIMPRO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2058934",
  "drug_name" : "220 ML GEMCITABINE 10 MG\\/ML INJECTION [INFUGEM]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2058946",
  "drug_name" : "1 ML OMALIZUMAB 150 MG\\/ML PREFILLED SYRINGE [XOLAIR]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2058950",
  "drug_name" : "0.5 ML OMALIZUMAB 150 MG\\/ML PREFILLED SYRINGE [XOLAIR]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2058980",
  "drug_name" : "ELTROMBOPAG 12.5 MG POWDER FOR ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2059017",
  "drug_name" : "RIVAROXABAN 2.5 MG ORAL TABLET [XARELTO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2059029",
  "drug_name" : "SARECYCLINE 100 MG ORAL TABLET [SEYSARA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "205918",
  "drug_name" : "1 ML EPOETIN ALFA 2000 UNT\\/ML INJECTION [PROCRIT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2059189",
  "drug_name" : "AMIKACIN LIPOSOMAL 70.3 MG\\/ML INHALATION SUSPENSION [ARIKAYCE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "205922",
  "drug_name" : "1 ML EPOETIN ALFA 3000 UNT\\/ML INJECTION [PROCRIT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "205924",
  "drug_name" : "1 ML EPOETIN ALFA 4000 UNT\\/ML INJECTION [PROCRIT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2059266",
  "drug_name" : "RILUZOLE 5 MG\\/ML ORAL SUSPENSION [TIGLUTIK]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2059280",
  "drug_name" : "OMADACYCLINE 150 MG ORAL TABLET [NUZYRA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "205964",
  "drug_name" : "CLINDAMYCIN 150 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "206417",
  "drug_name" : "ESTRADIOL CYPIONATE 5 MG\\/ML INJECTABLE SOLUTION [DEPO-ESTRADIOL]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "206423",
  "drug_name" : "CEFTAZIDIME 200 MG\\/ML INJECTABLE SOLUTION [TAZICEF]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "206791",
  "drug_name" : "MESALAMINE 250 MG EXTENDED RELEASE ORAL CAPSULE [PENTASA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "206831",
  "drug_name" : "ETOPOSIDE 20 MG\\/ML INJECTABLE SOLUTION [TOPOSAR]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "206842",
  "drug_name" : "ISOSORBIDE DINITRATE 20 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "206905",
  "drug_name" : "IBUPROFEN 400 MG ORAL TABLET [IBU]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "206913",
  "drug_name" : "IBUPROFEN 600 MG ORAL TABLET [IBU]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "206917",
  "drug_name" : "IBUPROFEN 800 MG ORAL TABLET [IBU]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "206969",
  "drug_name" : "INDOMETHACIN 50 MG RECTAL SUPPOSITORY [INDOCIN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "207059",
  "drug_name" : "INTERFERON BETA-1B 0.3 MG INJECTION [BETASERON]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "207088",
  "drug_name" : "METHSUXIMIDE 300 MG ORAL CAPSULE [CELONTIN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "207100",
  "drug_name" : "NATAMYCIN 50 MG\\/ML OPHTHALMIC SUSPENSION [NATACYN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "207136",
  "drug_name" : "METHYLPREDNISOLONE 2 MG ORAL TABLET [MEDROL]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "207273",
  "drug_name" : "NITROGLYCERIN 0.02 MG\\/MG TOPICAL OINTMENT [NITRO-BID]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "207347",
  "drug_name" : "PAROMOMYCIN 250 MG ORAL CAPSULE [HUMATIN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "207364",
  "drug_name" : "MINOCYCLINE 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "207373",
  "drug_name" : "MITOTANE 500 MG ORAL TABLET [LYSODREN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "207391",
  "drug_name" : "50 ML PENICILLIN G POTASSIUM 60000 UNT\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "207468",
  "drug_name" : "PENTOBARBITAL SODIUM 50 MG\\/ML INJECTABLE SOLUTION [NEMBUTAL]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "207588",
  "drug_name" : "PROCARBAZINE 50 MG ORAL CAPSULE [MATULANE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "207840",
  "drug_name" : "TIOPRONIN 100 MG ORAL TABLET [THIOLA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "207850",
  "drug_name" : "TOBRAMYCIN 0.003 MG\\/MG OPHTHALMIC OINTMENT [TOBREX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "207949",
  "drug_name" : "SUCCIMER 100 MG ORAL CAPSULE [CHEMET]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "208048",
  "drug_name" : "TOLMETIN 600 MG ORAL TABLET [TOLECTIN 600]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "208083",
  "drug_name" : "SARGRAMOSTIM 0.25 MG\\/ML INJECTABLE SOLUTION [LEUKINE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "208135",
  "drug_name" : "1 ML DIGOXIN 0.1 MG\\/ML INJECTION [LANOXIN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "208185",
  "drug_name" : "SILVER SULFADIAZINE 10 MG\\/ML TOPICAL CREAM [SSD]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "208327",
  "drug_name" : "TRETINOIN 0.25 MG\\/ML TOPICAL CREAM [AVITA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "208328",
  "drug_name" : "TRETINOIN 0.25 MG\\/ML TOPICAL CREAM [RETIN-A]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "208330",
  "drug_name" : "TRETINOIN 0.5 MG\\/ML TOPICAL CREAM [RETIN-A]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "208331",
  "drug_name" : "TRETINOIN 1 MG\\/ML TOPICAL CREAM [RETIN-A]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "208334",
  "drug_name" : "TRETINOIN 0.0001 MG\\/MG TOPICAL GEL [RETIN-A]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "208361",
  "drug_name" : "DIMETHYL SULFOXIDE 500 MG\\/ML IRRIGATION SOLUTION [RIMSO-50]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "208420",
  "drug_name" : "FLUOROMETHOLONE 2.5 MG\\/ML OPHTHALMIC SUSPENSION [FML FORTE LIQUIFILM]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "208821",
  "drug_name" : "DEXAMETHASONE 0.001 MG\\/MG \\/ TOBRAMYCIN 0.003 MG\\/MG OPHTHALMIC OINTMENT [TOBRADEX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "209002",
  "drug_name" : "PREDNISOLONE 1.2 MG\\/ML OPHTHALMIC SUSPENSION [PRED MILD]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "209029",
  "drug_name" : "50 ML CYTOMEGALOVIRUS IMMUNE GLOBULIN, HUMAN 50 MG\\/ML INJECTION [CYTOGAM]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "209788",
  "drug_name" : "CYSTEAMINE 150 MG ORAL CAPSULE [CYSTAGON]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "209789",
  "drug_name" : "CYSTEAMINE 50 MG ORAL CAPSULE [CYSTAGON]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2099302",
  "drug_name" : "1.14 ML DUPILUMAB 175 MG\\/ML PREFILLED SYRINGE [DUPIXENT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2099314",
  "drug_name" : "MOXETUMOMAB PASUDOTOX-TDFK 1 MG INJECTION [LUMOXITI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2099366",
  "drug_name" : "FLUOCINOLONE ACETONIDE 0.18 MG DRUG IMPLANT [YUTIQ]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2099769",
  "drug_name" : "LYMEPAK 14 TABLET, 21 DAY SUPPLY",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2099952",
  "drug_name" : "TALAZOPARIB 0.25 MG ORAL CAPSULE [TALZENNA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2099956",
  "drug_name" : "TALAZOPARIB 1 MG ORAL CAPSULE [TALZENNA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2101459",
  "drug_name" : "1 ML TBO-FILGRASTIM 0.3 MG\\/ML INJECTION [GRANIX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2101465",
  "drug_name" : "1.6 ML TBO-FILGRASTIM 0.3 MG\\/ML INJECTION [GRANIX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2101899",
  "drug_name" : "SODIUM POLYSTYRENE SULFONATE 15000 MG POWDER FOR ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2102713",
  "drug_name" : "CLOBAZAM 10 MG ORAL FILM [SYMPAZAN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2102715",
  "drug_name" : "CLOBAZAM 20 MG ORAL FILM [SYMPAZAN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2102717",
  "drug_name" : "CLOBAZAM 5 MG ORAL FILM [SYMPAZAN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2102784",
  "drug_name" : "REVEFENACIN 0.0583 MG\\/ML INHALATION SOLUTION [YUPELRI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2103175",
  "drug_name" : "LORLATINIB 25 MG ORAL TABLET [LORBRENA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2103179",
  "drug_name" : "LORLATINIB 100 MG ORAL TABLET [LORBRENA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2104341",
  "drug_name" : "CENEGERMIN-BKBJ 0.02 MG\\/ML OPHTHALMIC SOLUTION [OXERVATE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2104616",
  "drug_name" : "2 ML EMAPALUMAB-LZSG 5 MG\\/ML INJECTION [GAMIFANT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2104622",
  "drug_name" : "10 ML EMAPALUMAB-LZSG 5 MG\\/ML INJECTION [GAMIFANT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2105645",
  "drug_name" : "LAROTRECTINIB 100 MG ORAL CAPSULE [VITRAKVI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2105653",
  "drug_name" : "LAROTRECTINIB 20 MG\\/ML ORAL SOLUTION [VITRAKVI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2105657",
  "drug_name" : "LAROTRECTINIB 25 MG ORAL CAPSULE [VITRAKVI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2105817",
  "drug_name" : "GILTERITINIB 40 MG ORAL TABLET [XOSPATA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2105822",
  "drug_name" : "ACETAMINOPHEN 60 MG\\/ML \\/ OXYCODONE HYDROCHLORIDE 2 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2105856",
  "drug_name" : "GLASDEGIB 100 MG ORAL TABLET [DAURISMO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2105860",
  "drug_name" : "GLASDEGIB 25 MG ORAL TABLET [DAURISMO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2106075",
  "drug_name" : "0.9 ML TOCILIZUMAB 180 MG\\/ML AUTO-INJECTOR [ACTEMRA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2106334",
  "drug_name" : "0.5 ML DIPHTHERIA TOXOID VACCINE, INACTIVATED 4 UNT\\/ML \\/ TETANUS TOXOID VACCINE, INACTIVATED 4 UNT\\/ML INJECTION [TDVAX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2106373",
  "drug_name" : "LEVOLEUCOVORIN 175 MG INJECTION [KHAPZORY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2106377",
  "drug_name" : "LEVOLEUCOVORIN 300 MG INJECTION [KHAPZORY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2107058",
  "drug_name" : "TRASTUZUMAB-PKRB 21 MG\\/ML INJECTABLE SOLUTION [HERZUMA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2107518",
  "drug_name" : "AMIFAMPRIDINE 10 MG ORAL TABLET [FIRDAPSE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2107621",
  "drug_name" : "LEVODOPA 42 MG INHALATION POWDER [INBRIJA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2109064",
  "drug_name" : "1 ML TAGRAXOFUSP-ERZS 1 MG\\/ML INJECTION [ELZONRIS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2109239",
  "drug_name" : "TAFENOQUINE 150 MG ORAL TABLET [KRINTAFEL]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2110510",
  "drug_name" : "60 ACTUAT FLUTICASONE PROPIONATE 0.1 MG\\/ACTUAT \\/ SALMETEROL 0.05 MG\\/ACTUAT DRY POWDER INHALER [WIXELA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2110513",
  "drug_name" : "60 ACTUAT FLUTICASONE PROPIONATE 0.25 MG\\/ACTUAT \\/ SALMETEROL 0.05 MG\\/ACTUAT DRY POWDER INHALER [WIXELA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2110516",
  "drug_name" : "60 ACTUAT FLUTICASONE PROPIONATE 0.5 MG\\/ACTUAT \\/ SALMETEROL 0.05 MG\\/ACTUAT DRY POWDER INHALER [WIXELA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2110618",
  "drug_name" : "CAPLACIZUMAB-YHDP 11 MG INJECTION [CABLIVI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2110774",
  "drug_name" : "84 HR ESTRADIOL 0.00104 MG\\/HR TRANSDERMAL SYSTEM [DOTTI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2110777",
  "drug_name" : "84 HR ESTRADIOL 0.00156 MG\\/HR TRANSDERMAL SYSTEM [DOTTI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2110780",
  "drug_name" : "84 HR ESTRADIOL 0.00208 MG\\/HR TRANSDERMAL SYSTEM [DOTTI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2110783",
  "drug_name" : "84 HR ESTRADIOL 0.00313 MG\\/HR TRANSDERMAL SYSTEM [DOTTI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2110786",
  "drug_name" : "84 HR ESTRADIOL 0.00417 MG\\/HR TRANSDERMAL SYSTEM [DOTTI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "211140",
  "drug_name" : "PENTOSAN POLYSULFATE 100 MG ORAL CAPSULE [ELMIRON]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2118741",
  "drug_name" : "1 ML GUSELKUMAB 100 MG\\/ML AUTO-INJECTOR [TREMFYA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2119389",
  "drug_name" : "SPRAVATO 84 MG DOSE KIT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2119391",
  "drug_name" : "SPRAVATO 56 MG DOSE KIT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2119696",
  "drug_name" : "14 ML ATEZOLIZUMAB 60 MG\\/ML INJECTION [TECENTRIQ]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2119719",
  "drug_name" : "5 ML HYALURONIDASE-OYSK 2000 UNT\\/ML \\/ TRASTUZUMAB-OYSK 120 MG\\/ML INJECTION [HERCEPTIN HYLECTA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "211975",
  "drug_name" : "ESTROGENS, CONJUGATED (USP) 25 MG INJECTION [PREMARIN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2121061",
  "drug_name" : "CERITINIB 150 MG ORAL TABLET [ZYKADIA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2121100",
  "drug_name" : "SIPONIMOD 2 MG ORAL TABLET [MAYZENT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "212118",
  "drug_name" : "NELFINAVIR 250 MG ORAL TABLET [VIRACEPT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2121426",
  "drug_name" : "5 ML CALASPARGASE PEGOL-MKNL 750 UNT\\/ML INJECTION [ASPARLAS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "212219",
  "drug_name" : "EPOETIN ALFA 20000 UNT\\/ML INJECTABLE SOLUTION [PROCRIT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2122526",
  "drug_name" : "DOLUTEGRAVIR 50 MG \\/ LAMIVUDINE 300 MG ORAL TABLET [DOVATO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2122650",
  "drug_name" : "MAVENCLAD 7 TABLET PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2122657",
  "drug_name" : "MAVENCLAD 5 TABLET PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2123042",
  "drug_name" : "50 ML IMMUNE GLOBULIN INTRAVENOUS (HUMAN) - SLRA 100 MG\\/ML INJECTION [ASCENIV]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2123072",
  "drug_name" : "NDA021457 200 ACTUAT ALBUTEROL 0.09 MG\\/ACTUAT METERED DOSE INHALER",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2123076",
  "drug_name" : "NDA020983 200 ACTUAT ALBUTEROL 0.09 MG\\/ACTUAT METERED DOSE INHALER",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2123111",
  "drug_name" : "NDA020503 200 ACTUAT ALBUTEROL 0.09 MG\\/ACTUAT METERED DOSE INHALER",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2123137",
  "drug_name" : "ERDAFITINIB 3 MG ORAL TABLET [BALVERSA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2123141",
  "drug_name" : "ERDAFITINIB 4 MG ORAL TABLET [BALVERSA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2123145",
  "drug_name" : "ERDAFITINIB 5 MG ORAL TABLET [BALVERSA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2123194",
  "drug_name" : "PULMONARY HYPERTENSION TADALAFIL 20 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "212787",
  "drug_name" : "CIMETIDINE 60 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "212957",
  "drug_name" : "CYCLOSPORINE 100 MG\\/ML ORAL SOLUTION [SANDIMMUNE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "213197",
  "drug_name" : "BECAPLERMIN 0.0001 MG\\/MG TOPICAL GEL [REGRANEX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "213282",
  "drug_name" : "HYDROXYUREA 200 MG ORAL CAPSULE [DROXIA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "213283",
  "drug_name" : "HYDROXYUREA 300 MG ORAL CAPSULE [DROXIA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "213284",
  "drug_name" : "HYDROXYUREA 400 MG ORAL CAPSULE [DROXIA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "213307",
  "drug_name" : "CIPROFLOXACIN 0.003 MG\\/MG OPHTHALMIC OINTMENT [CILOXAN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "213337",
  "drug_name" : "SACROSIDASE 8500 UNT\\/ML ORAL SOLUTION [SUCRAID]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "213360",
  "drug_name" : "THALIDOMIDE 50 MG ORAL CAPSULE [THALOMID]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "213475",
  "drug_name" : "1 ML EPOETIN ALFA 40000 UNT\\/ML INJECTION [PROCRIT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "213484",
  "drug_name" : "LAMIVUDINE 5 MG\\/ML ORAL SOLUTION [EPIVIR HBV]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "213502",
  "drug_name" : "ALITRETINOIN 0.001 MG\\/MG TOPICAL GEL [PANRETIN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "213510",
  "drug_name" : "AURANOFIN 3 MG ORAL CAPSULE [RIDAURA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "213557",
  "drug_name" : "ACETOHYDROXAMIC ACID 250 MG ORAL TABLET [LITHOSTAT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2166401",
  "drug_name" : "IVACAFTOR 25 MG ORAL GRANULES [KALYDECO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2167152",
  "drug_name" : "6 ML IMMUNE GLOBULIN SUBCUTANEOUS (HUMAN) - HIPP 165 MG\\/ML INJECTION [CUTAQUIG]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2167157",
  "drug_name" : "12 ML IMMUNE GLOBULIN SUBCUTANEOUS (HUMAN) - HIPP 165 MG\\/ML INJECTION [CUTAQUIG]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2167159",
  "drug_name" : "10 ML IMMUNE GLOBULIN SUBCUTANEOUS (HUMAN) - HIPP 165 MG\\/ML INJECTION [CUTAQUIG]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2167161",
  "drug_name" : "20 ML IMMUNE GLOBULIN SUBCUTANEOUS (HUMAN) - HIPP 165 MG\\/ML INJECTION [CUTAQUIG]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2167163",
  "drug_name" : "24 ML IMMUNE GLOBULIN SUBCUTANEOUS (HUMAN) - HIPP 165 MG\\/ML INJECTION [CUTAQUIG]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2167165",
  "drug_name" : "48 ML IMMUNE GLOBULIN SUBCUTANEOUS (HUMAN) - HIPP 165 MG\\/ML INJECTION [CUTAQUIG]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2168540",
  "drug_name" : "TAFAMIDIS 61 MG ORAL CAPSULE [VYNDAMAX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2168548",
  "drug_name" : "TAFAMIDIS MEGLUMINE 20 MG ORAL CAPSULE [VYNDAQEL]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2168596",
  "drug_name" : "IVABRADINE 1 MG\\/ML ORAL SOLUTION [CORLANOR]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2169314",
  "drug_name" : "PIQRAY 200 MG DAILY DOSE PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2169320",
  "drug_name" : "PIQRAY 250 MG DAILY DOSE PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2169322",
  "drug_name" : "PIQRAY 300 MG DAILY DOSE PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2169362",
  "drug_name" : "TRASTUZUMAB-PKRB 150 MG INJECTION [HERZUMA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2170993",
  "drug_name" : "1 ML MEPOLIZUMAB 100 MG\\/ML AUTO-INJECTOR [NUCALA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2173500",
  "drug_name" : "MIDAZOLAM 50 MG\\/ML NASAL SPRAY [NAYZILAM]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2173822",
  "drug_name" : "1 ML MEPOLIZUMAB 100 MG\\/ML PREFILLED SYRINGE [NUCALA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2174100",
  "drug_name" : "POLATUZUMAB VEDOTIN-PIIQ 140 MG INJECTION [POLIVY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2174390",
  "drug_name" : "SYMDEKO 50 MG \\/ 75 MG AND 75 MG PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2174809",
  "drug_name" : "TRASTUZUMAB-ANNS 21 MG\\/ML INJECTABLE SOLUTION [KANJINTI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2178075",
  "drug_name" : "TIOPRONIN 100 MG DELAYED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2178079",
  "drug_name" : "TIOPRONIN 300 MG DELAYED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2178266",
  "drug_name" : "BENDAMUSTINE HYDROCHLORIDE 25 MG\\/ML INJECTABLE SOLUTION [BELRAPZO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2178407",
  "drug_name" : "XPOVIO 80 MG TWICE WEEKLY (160 MG TOTAL WEEKLY) DOSE CARTON PACK, 4 BLISTER CARDS, 8 TABLETS EACH",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2179758",
  "drug_name" : "TRASTUZUMAB-DKST 150 MG INJECTION [OGIVRI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2179763",
  "drug_name" : "TRASTUZUMAB-DKST 21 MG\\/ML INJECTABLE SOLUTION [OGIVRI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2180336",
  "drug_name" : "DAROLUTAMIDE 300 MG ORAL TABLET [NUBEQA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2180671",
  "drug_name" : "GLUCAGON 3 MG NASAL POWDER [BAQSIMI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2180997",
  "drug_name" : "DEFERIPRONE 1000 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2180999",
  "drug_name" : "DEFERIPRONE 1000 MG ORAL TABLET [FERRIPROX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2182340",
  "drug_name" : "1 ML ETANERCEPT 50 MG\\/ML CARTRIDGE [ENBREL]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2183131",
  "drug_name" : "PEXIDARTINIB 200 MG ORAL CAPSULE [TURALIO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2184147",
  "drug_name" : "CILASTATIN 500 MG \\/ IMIPENEM 500 MG \\/ RELEBACTAM 250 MG INJECTION [RECARBRIO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2196900",
  "drug_name" : "24 HR UPADACITINIB 15 MG EXTENDED RELEASE ORAL TABLET [RINVOQ]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2197501",
  "drug_name" : "FEDRATINIB 100 MG ORAL CAPSULE [INREBIC]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2197873",
  "drug_name" : "ENTRECTINIB 100 MG ORAL CAPSULE [ROZLYTREK]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2197877",
  "drug_name" : "ENTRECTINIB 200 MG ORAL CAPSULE [ROZLYTREK]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2197890",
  "drug_name" : "PITOLISANT 4.45 MG ORAL TABLET [WAKIX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2197894",
  "drug_name" : "PITOLISANT 17.8 MG ORAL TABLET [WAKIX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2198370",
  "drug_name" : "PRETOMANID 200 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2198792",
  "drug_name" : "10 ML SODIUM BICARBONATE 42 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2198953",
  "drug_name" : "15 ML LEFAMULIN 10 MG\\/ML INJECTION [XENLETA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2199026",
  "drug_name" : "ISTRADEFYLLINE 20 MG ORAL TABLET [NOURIANZ]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2199030",
  "drug_name" : "ISTRADEFYLLINE 40 MG ORAL TABLET [NOURIANZ]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2200174",
  "drug_name" : "SPRINKLE DULOXETINE 20 MG DELAYED RELEASE ORAL CAPSULE [DRIZALMA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2200177",
  "drug_name" : "SPRINKLE DULOXETINE 30 MG DELAYED RELEASE ORAL CAPSULE [DRIZALMA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2200180",
  "drug_name" : "SPRINKLE DULOXETINE 40 MG DELAYED RELEASE ORAL CAPSULE [DRIZALMA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2200183",
  "drug_name" : "SPRINKLE DULOXETINE 60 MG DELAYED RELEASE ORAL CAPSULE [DRIZALMA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2201540",
  "drug_name" : "ROMIPLOSTIM 0.125 MG INJECTION [NPLATE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2203893",
  "drug_name" : "SOFOSBUVIR 200 MG ORAL TABLET [SOVALDI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2203897",
  "drug_name" : "LEDIPASVIR 45 MG \\/ SOFOSBUVIR 200 MG ORAL TABLET [HARVONI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2203999",
  "drug_name" : "SOFOSBUVIR 150 MG ORAL PELLET [SOVALDI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2204092",
  "drug_name" : "SOFOSBUVIR 200 MG ORAL PELLET [SOVALDI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2204102",
  "drug_name" : "LEDIPASVIR 33.75 MG \\/ SOFOSBUVIR 150 MG ORAL PELLET [HARVONI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2204104",
  "drug_name" : "LEDIPASVIR 45 MG \\/ SOFOSBUVIR 200 MG ORAL PELLET [HARVONI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2204925",
  "drug_name" : "0.05 ML BROLUCIZUMAB-DBLL 120 MG\\/ML INJECTION [BEOVU]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2205474",
  "drug_name" : "BARICITINIB 1 MG ORAL TABLET [OLUMIANT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2205634",
  "drug_name" : "1 ML BENRALIZUMAB 30 MG\\/ML AUTO-INJECTOR [FASENRA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2257013",
  "drug_name" : "TRIKAFTA 100 MG \\/ 50 MG \\/ 75 MG AND 150 MG TABLET PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2257300",
  "drug_name" : "TRASTUZUMAB-ANNS 150 MG INJECTION [KANJINTI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2261794",
  "drug_name" : "DIROXIMEL FUMARATE 231 MG DELAYED RELEASE ORAL CAPSULE [VUMERITY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2262430",
  "drug_name" : "10 ML CRIZANLIZUMAB-TMCA 10 MG\\/ML INJECTION [ADAKVEO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2262446",
  "drug_name" : "ZANUBRUTINIB 80 MG ORAL CAPSULE [BRUKINSA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2262911",
  "drug_name" : "LUSPATERCEPT-AAMT 25 MG INJECTION [REBLOZYL]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2262915",
  "drug_name" : "LUSPATERCEPT-AAMT 75 MG INJECTION [REBLOZYL]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "226343",
  "drug_name" : "DEXAMETHASONE PHOSPHATE 1 MG\\/ML OPHTHALMIC SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "226552",
  "drug_name" : "72 HR SCOPOLAMINE 0.0139 MG\\/HR TRANSDERMAL SYSTEM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2265701",
  "drug_name" : "CENOBAMATE 50 MG ORAL TABLET [XCOPRI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2265711",
  "drug_name" : "CEFIDEROCOL 1000 MG INJECTION [FETROJA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2265721",
  "drug_name" : "1 ML GIVOSIRAN 189 MG\\/ML INJECTION [GIVLAARI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2265729",
  "drug_name" : "24 HR ASENAPINE 0.158 MG\\/HR TRANSDERMAL SYSTEM [SECUADO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2265732",
  "drug_name" : "24 HR ASENAPINE 0.238 MG\\/HR TRANSDERMAL SYSTEM [SECUADO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2265735",
  "drug_name" : "24 HR ASENAPINE 0.317 MG\\/HR TRANSDERMAL SYSTEM [SECUADO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2266506",
  "drug_name" : "21 DAY ETHINYL ESTRADIOL 0.000625 MG\\/HR \\/ ETONOGESTREL 0.005 MG\\/HR VAGINAL SYSTEM [ELURYNG]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2266530",
  "drug_name" : "INFLIXIMAB-AXXQ 100 MG INJECTION [AVSOLA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "226719",
  "drug_name" : "ETOPOSIDE 100 MG INJECTION [ETOPOPHOS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2267216",
  "drug_name" : "2 ML GOLODIRSEN 50 MG\\/ML INJECTION [VYONDYS 53]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2267581",
  "drug_name" : "FAM-TRASTUZUMAB DERUXTECAN-NXKI 100 MG INJECTION [ENHERTU]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2268044",
  "drug_name" : "4 ML BEVACIZUMAB-BVZR 25 MG\\/ML INJECTION [ZIRABEV]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2268048",
  "drug_name" : "16 ML BEVACIZUMAB-BVZR 25 MG\\/ML INJECTION [ZIRABEV]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2268227",
  "drug_name" : "UBROGEPANT 100 MG ORAL TABLET [UBRELVY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2268231",
  "drug_name" : "UBROGEPANT 50 MG ORAL TABLET [UBRELVY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2268315",
  "drug_name" : "ENFORTUMAB VEDOTIN-EJFV 20 MG INJECTION [PADCEV]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2268319",
  "drug_name" : "ENFORTUMAB VEDOTIN-EJFV 30 MG INJECTION [PADCEV]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2272118",
  "drug_name" : "AVAPRITINIB 100 MG ORAL TABLET [AYVAKIT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2272122",
  "drug_name" : "AVAPRITINIB 200 MG ORAL TABLET [AYVAKIT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2272126",
  "drug_name" : "AVAPRITINIB 300 MG ORAL TABLET [AYVAKIT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2272622",
  "drug_name" : "VALTOCO 10 MG DOSE KIT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2272624",
  "drug_name" : "VALTOCO 20 MG DOSE KIT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2272630",
  "drug_name" : "VALTOCO 5 MG DOSE KIT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2272636",
  "drug_name" : "VALTOCO 15 MG DOSE KIT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2273107",
  "drug_name" : "24 HR BUDESONIDE 6 MG EXTENDED RELEASE ORAL CAPSULE [ORTIKOS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2273110",
  "drug_name" : "24 HR BUDESONIDE 9 MG EXTENDED RELEASE ORAL CAPSULE [ORTIKOS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2273115",
  "drug_name" : "24 HR TOFACITINIB 22 MG EXTENDED RELEASE ORAL TABLET [XELJANZ]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2273517",
  "drug_name" : "10 ML RITUXIMAB-PVVR 10 MG\\/ML INJECTION [RUXIENCE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2273521",
  "drug_name" : "50 ML RITUXIMAB-PVVR 10 MG\\/ML INJECTION [RUXIENCE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2274390",
  "drug_name" : "TAZEMETOSTAT 200 MG ORAL TABLET [TAZVERIK]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2274812",
  "drug_name" : "TEPROTUMUMAB-TRBW 500 MG INJECTION [TEPEZZA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2275613",
  "drug_name" : "LUMATEPERONE 42 MG ORAL CAPSULE [CAPLYTA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2279419",
  "drug_name" : "PALFORZIA INITIAL DOSE ESCALATION KIT (4 - 17 YEARS)",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2279425",
  "drug_name" : "PALFORZIA 40 MG (LEVEL 5) KIT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2279427",
  "drug_name" : "PALFORZIA 3 MG (LEVEL 1) KIT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2279429",
  "drug_name" : "PALFORZIA 6 MG (LEVEL 2) KIT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2279435",
  "drug_name" : "PALFORZIA 12 MG (LEVEL 3) KIT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2279437",
  "drug_name" : "PALFORZIA 20 MG (LEVEL 4) KIT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2279439",
  "drug_name" : "PALFORZIA 80 MG (LEVEL 6) KIT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2279445",
  "drug_name" : "PALFORZIA 120 MG (LEVEL 7) KIT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2279447",
  "drug_name" : "PALFORZIA 160 MG (LEVEL 8) KIT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2279449",
  "drug_name" : "PALFORZIA 200 MG (LEVEL 9) KIT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2279451",
  "drug_name" : "PALFORZIA 240 MG (LEVEL 10) KIT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2279457",
  "drug_name" : "PALFORZIA 300 MG (LEVEL 11) KIT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2279847",
  "drug_name" : "FIDAXOMICIN 40 MG\\/ML ORAL SUSPENSION [DIFICID]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2280737",
  "drug_name" : "TRASTUZUMAB-QYYP 21 MG\\/ML INJECTABLE SOLUTION [TRAZIMERA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2282028",
  "drug_name" : "5 ML ISATUXIMAB-IRFC 20 MG\\/ML INJECTION [SARCLISA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2282032",
  "drug_name" : "25 ML ISATUXIMAB-IRFC 20 MG\\/ML INJECTION [SARCLISA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2282320",
  "drug_name" : "RIMEGEPANT 75 MG DISINTEGRATING ORAL TABLET [NURTEC]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2283505",
  "drug_name" : "CENOBAMATE 100 MG ORAL TABLET [XCOPRI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2283509",
  "drug_name" : "CENOBAMATE 150 MG ORAL TABLET [XCOPRI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2283513",
  "drug_name" : "CENOBAMATE 200 MG ORAL TABLET [XCOPRI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2283518",
  "drug_name" : "XCOPRI 350 MG MAINTENANCE PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2283527",
  "drug_name" : "CENOBAMATE 25 MG ORAL TABLET [XCOPRI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2283536",
  "drug_name" : "XCOPRI TITRATION PACK - 50 MG (14), 100 MG (14) 28 COUNT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2283538",
  "drug_name" : "XCOPRI TITRATION PACK - 12.5 MG (14), 25 MG (14) 28 COUNT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2283540",
  "drug_name" : "XCOPRI TITRATION PACK - 150 MG (14), 200 MG (14) 28 COUNT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2284104",
  "drug_name" : "PALBOCICLIB 100 MG ORAL TABLET [IBRANCE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2284106",
  "drug_name" : "PALBOCICLIB 125 MG ORAL TABLET [IBRANCE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2284108",
  "drug_name" : "PALBOCICLIB 75 MG ORAL TABLET [IBRANCE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2286281",
  "drug_name" : "OSILODROSTAT 1 MG ORAL TABLET [ISTURISA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2286285",
  "drug_name" : "OSILODROSTAT 10 MG ORAL TABLET [ISTURISA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2286290",
  "drug_name" : "OSILODROSTAT 5 MG ORAL TABLET [ISTURISA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2286607",
  "drug_name" : "BIMATOPROST 0.01 MG DRUG IMPLANT [DURYSTA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2287905",
  "drug_name" : "1.5 ML FREMANEZUMAB-VFRM 150 MG\\/ML AUTO-INJECTOR [AJOVY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2288412",
  "drug_name" : "OZANIMOD 0.92 MG ORAL CAPSULE [ZEPOSIA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2288431",
  "drug_name" : "ZEPOSIA 37-DAY STARTER KIT (7-DAY STARTER PACK AND 0.92 MG 30 COUNT BOTTLE)",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2288433",
  "drug_name" : "ZEPOSIA 7-DAY STARTER PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2288816",
  "drug_name" : "SOFOSBUVIR 200 MG \\/ VELPATASVIR 50 MG ORAL TABLET [EPCLUSA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2289232",
  "drug_name" : "TRASTUZUMAB-DTTB 150 MG INJECTION [ONTRUZANT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2289237",
  "drug_name" : "TRASTUZUMAB-DTTB 21 MG\\/ML INJECTABLE SOLUTION [ONTRUZANT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2289424",
  "drug_name" : "SELUMETINIB 10 MG ORAL CAPSULE [KOSELUGO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2289428",
  "drug_name" : "SELUMETINIB 25 MG ORAL CAPSULE [KOSELUGO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2359340",
  "drug_name" : "PEMIGATINIB 13.5 MG ORAL TABLET [PEMAZYRE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2359344",
  "drug_name" : "PEMIGATINIB 4.5 MG ORAL TABLET [PEMAZYRE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2359348",
  "drug_name" : "PEMIGATINIB 9 MG ORAL TABLET [PEMAZYRE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2360539",
  "drug_name" : "SACITUZUMAB GOVITECAN-HZIY 180 MG INJECTION [TRODELVY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2360588",
  "drug_name" : "[MENQUADFI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2361296",
  "drug_name" : "TUCATINIB 150 MG ORAL TABLET [TUKYSA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2361300",
  "drug_name" : "TUCATINIB 50 MG ORAL TABLET [TUKYSA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2361313",
  "drug_name" : "NIMODIPINE 6 MG\\/ML ORAL SOLUTION [NYMALIZE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2362240",
  "drug_name" : "CAPMATINIB 150 MG ORAL TABLET [TABRECTA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2362244",
  "drug_name" : "CAPMATINIB 200 MG ORAL TABLET [TABRECTA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2369403",
  "drug_name" : "RIPRETINIB 50 MG ORAL TABLET [QINLOCK]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2370170",
  "drug_name" : "SELPERCATINIB 40 MG ORAL CAPSULE [RETEVMO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2370174",
  "drug_name" : "SELPERCATINIB 80 MG ORAL CAPSULE [RETEVMO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2371050",
  "drug_name" : "APOMORPHINE HYDROCHLORIDE 10 MG SUBLINGUAL FILM [KYNMOBI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2371054",
  "drug_name" : "APOMORPHINE HYDROCHLORIDE 15 MG SUBLINGUAL FILM [KYNMOBI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2371058",
  "drug_name" : "APOMORPHINE HYDROCHLORIDE 20 MG SUBLINGUAL FILM [KYNMOBI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2371062",
  "drug_name" : "APOMORPHINE HYDROCHLORIDE 25 MG SUBLINGUAL FILM [KYNMOBI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2371066",
  "drug_name" : "APOMORPHINE HYDROCHLORIDE 30 MG SUBLINGUAL FILM [KYNMOBI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2371773",
  "drug_name" : "0.375 ML LEUPROLIDE ACETATE 120 MG\\/ML PREFILLED SYRINGE [FENSOLVI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "237178",
  "drug_name" : "THEOPHYLLINE 100 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "237205",
  "drug_name" : "10 ML NITROGLYCERIN 5 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "237367",
  "drug_name" : "1000 ML POTASSIUM CHLORIDE 0.04 MEQ\\/ML \\/ SODIUM CHLORIDE 9 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "237381",
  "drug_name" : "POTASSIUM ACETATE 2 MEQ\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2373941",
  "drug_name" : "BEDAQUILINE 20 MG ORAL TABLET [SIRTURO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2374332",
  "drug_name" : "ARTESUNATE 110 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2374566",
  "drug_name" : "DOLUTEGRAVIR 5 MG TABLET FOR ORAL SUSPENSION [TIVICAY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2374738",
  "drug_name" : "LURBINECTEDIN 4 MG INJECTION [ZEPZELCA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2375141",
  "drug_name" : "15 ML DARATUMUMAB-FIHJ 120 MG\\/ML \\/ HYALURONIDASE-FIHJ 2000 UNT\\/ML INJECTION [DARZALEX FASPRO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2375329",
  "drug_name" : "2 ML DUPILUMAB 150 MG\\/ML AUTO-INJECTOR [DUPIXENT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "237656",
  "drug_name" : "GLUCOSE 700 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "237788",
  "drug_name" : "LEUCOVORIN 350 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "238013",
  "drug_name" : "OXYTOCIN 10 UNT\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2380551",
  "drug_name" : "12 HR FOSTEMSAVIR 600 MG EXTENDED RELEASE ORAL TABLET [RUKOBIA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2380772",
  "drug_name" : "20 ML EMAPALUMAB-LZSG 5 MG\\/ML INJECTION [GAMIFANT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2381144",
  "drug_name" : "FENFLURAMINE 2.2 MG\\/ML ORAL SOLUTION [FINTEPLA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "238134",
  "drug_name" : "ASPIRIN 325 MG \\/ BUTALBITAL 50 MG \\/ CAFFEINE 40 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "238151",
  "drug_name" : "MESALAMINE 66.7 MG\\/ML ENEMA",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "238154",
  "drug_name" : "ACETAMINOPHEN 325 MG \\/ BUTALBITAL 50 MG \\/ CAFFEINE 40 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2382609",
  "drug_name" : "15 ML HYALURONIDASE-ZZXF 2000 UNT\\/ML \\/ PERTUZUMAB-ZZXF 80 MG\\/ML \\/ TRASTUZUMAB-ZZXF 40 MG\\/ML INJECTION [PHESGO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2382990",
  "drug_name" : "XPOVIO 60 MG TWICE WEEKLY (120 MG TOTAL WEEKLY) DOSE CARTON PACK, 4 BLISTER CARDS, 6 TABLETS EACH",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2383307",
  "drug_name" : "10 ML HYALURONIDASE-ZZXF 2000 UNT\\/ML \\/ PERTUZUMAB-ZZXF 60 MG\\/ML \\/ TRASTUZUMAB-ZZXF 60 MG\\/ML INJECTION [PHESGO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2384465",
  "drug_name" : "INQOVI 5 TABLET PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "238600",
  "drug_name" : "SELENIUM SULFIDE 25 MG\\/ML MEDICATED SHAMPOO",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2386859",
  "drug_name" : "CYCLOPHOSPHAMIDE 200 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "238720",
  "drug_name" : "10 ML TRANEXAMIC ACID 100 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2387331",
  "drug_name" : "120 ACTUAT BUDESONIDE 0.16 MG\\/ACTUAT \\/ FORMOTEROL FUMARATE 0.0048 MG\\/ACTUAT \\/ GLYCOPYRROLATE 0.009 MG\\/ACTUAT METERED DOSE INHALER [BREZTRI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2387343",
  "drug_name" : "TAFASITAMAB-CXIX 200 MG INJECTION [MONJUVI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "238920",
  "drug_name" : "BETAMETHASONE 0.5 MG\\/ML TOPICAL CREAM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2389849",
  "drug_name" : "5 ML VILTOLARSEN 50 MG\\/ML INJECTION [VILTEPSO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2390646",
  "drug_name" : "ENZALUTAMIDE 40 MG ORAL TABLET [XTANDI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2390650",
  "drug_name" : "ENZALUTAMIDE 80 MG ORAL TABLET [XTANDI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2390946",
  "drug_name" : "RISDIPLAM 0.75 MG\\/ML ORAL SOLUTION [EVRYSDI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2390954",
  "drug_name" : "0.4 ML OFATUMUMAB 50 MG\\/ML PEN INJECTOR [KESIMPTA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "239177",
  "drug_name" : "FLUOROURACIL 50 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "239178",
  "drug_name" : "VINBLASTINE SULFATE 1 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "239179",
  "drug_name" : "DACTINOMYCIN 0.5 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "239189",
  "drug_name" : "NAFCILLIN 100 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "239191",
  "drug_name" : "AMOXICILLIN 50 MG\\/ML ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "239200",
  "drug_name" : "CHLORAMPHENICOL 100 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "239209",
  "drug_name" : "VANCOMYCIN 100 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2392142",
  "drug_name" : "0.5 ML ETANERCEPT 50 MG\\/ML INJECTION [ENBREL]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "239238",
  "drug_name" : "GRISEOFULVIN 25 MG\\/ML ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "239239",
  "drug_name" : "GRISEOFULVIN 250 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "239240",
  "drug_name" : "AMPHOTERICIN B 50 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2394947",
  "drug_name" : "PRALSETINIB 100 MG ORAL CAPSULE [GAVRETO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2395502",
  "drug_name" : "REMDESIVIR 100 MG INJECTION [VEKLURY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2395808",
  "drug_name" : "TRAMADOL HYDROCHLORIDE 5 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2395814",
  "drug_name" : "TRAMADOL HYDROCHLORIDE 5 MG\\/ML ORAL SOLUTION [QDOLO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2396770",
  "drug_name" : "AZACITIDINE 200 MG ORAL TABLET [ONUREG]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2396774",
  "drug_name" : "AZACITIDINE 300 MG ORAL TABLET [ONUREG]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2398133",
  "drug_name" : "POLATUZUMAB VEDOTIN-PIIQ 30 MG INJECTION [POLIVY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2398842",
  "drug_name" : "3 ML SEMAGLUTIDE 1.34 MG\\/ML PEN INJECTOR [OZEMPIC]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "239983",
  "drug_name" : "AZATHIOPRINE 100 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "240209",
  "drug_name" : "BETAMETHASONE 0.5 MG\\/ML TOPICAL LOTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "240416",
  "drug_name" : "CYTARABINE 20 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "240637",
  "drug_name" : "50 ML OXACILLIN 40 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "240741",
  "drug_name" : "CLARITHROMYCIN 25 MG\\/ML ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "240754",
  "drug_name" : "10 ML CLADRIBINE 1 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "240793",
  "drug_name" : "2 ML SODIUM NITROPRUSSIDE 25 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "240984",
  "drug_name" : "AMPICILLIN 100 MG\\/ML \\/ SULBACTAM 50 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "241834",
  "drug_name" : "CYCLOSPORINE, MODIFIED 100 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "241946",
  "drug_name" : "84 HR ESTRADIOL 0.00156 MG\\/HR TRANSDERMAL SYSTEM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "242120",
  "drug_name" : "INSULIN LISPRO 100 UNT\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "242438",
  "drug_name" : "MONTELUKAST 5 MG CHEWABLE TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "242446",
  "drug_name" : "OFLOXACIN 3 MG\\/ML OTIC SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "242461",
  "drug_name" : "CILOSTAZOL 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "242462",
  "drug_name" : "CILOSTAZOL 50 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "242679",
  "drug_name" : "ABACAVIR 300 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "242680",
  "drug_name" : "ABACAVIR 20 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "242736",
  "drug_name" : "METRONIDAZOLE 7.5 MG\\/ML TOPICAL LOTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "242800",
  "drug_name" : "CEFTAZIDIME 200 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "242816",
  "drug_name" : "100 ML GENTAMICIN 1 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "242831",
  "drug_name" : "GRISEOFULVIN 125 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "242891",
  "drug_name" : "84 HR ESTRADIOL 0.00208 MG\\/HR TRANSDERMAL SYSTEM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "242892",
  "drug_name" : "84 HR ESTRADIOL 0.00417 MG\\/HR TRANSDERMAL SYSTEM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "242969",
  "drug_name" : "4 ML NOREPINEPHRINE 1 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "244098",
  "drug_name" : "1000 ML GLUCOSE 100 MG\\/ML \\/ SODIUM CHLORIDE 4.5 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "244374",
  "drug_name" : "BENZOYL PEROXIDE 0.05 MG\\/MG \\/ ERYTHROMYCIN 0.03 MG\\/MG TOPICAL GEL",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "244967",
  "drug_name" : "POLYMYXIN B 10000 UNT\\/ML \\/ TRIMETHOPRIM 1 MG\\/ML OPHTHALMIC SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "245134",
  "drug_name" : "72 HR FENTANYL 0.025 MG\\/HR TRANSDERMAL SYSTEM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "245135",
  "drug_name" : "72 HR FENTANYL 0.05 MG\\/HR TRANSDERMAL SYSTEM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "245136",
  "drug_name" : "72 HR FENTANYL 0.1 MG\\/HR TRANSDERMAL SYSTEM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "245248",
  "drug_name" : "GRISEOFULVIN 165 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "245314",
  "drug_name" : "ALBUTEROL 5 MG\\/ML INHALATION SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2461136",
  "drug_name" : "11 ML RAVULIZUMAB-CWVZ 100 MG\\/ML INJECTION [ULTOMIRIS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2461140",
  "drug_name" : "3 ML RAVULIZUMAB-CWVZ 100 MG\\/ML INJECTION [ULTOMIRIS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "246172",
  "drug_name" : "CLOBAZAM 20 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2463737",
  "drug_name" : "EPOETIN ALFA-EPBX 20000 UNT\\/ML INJECTABLE SOLUTION [RETACRIT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2464832",
  "drug_name" : "0.5 ML MODIFIED VACCINIA ANKARA-BAVARIAN NORDIC 198000000 UNT\\/ML INJECTION [JYNNEOS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2467158",
  "drug_name" : "0.5 ML LUMASIRAN 189 MG\\/ML INJECTION [OXLUMO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2467571",
  "drug_name" : "BEROTRALSTAT 150 MG ORAL CAPSULE [ORLADEYO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2467588",
  "drug_name" : "LONAFARNIB 50 MG ORAL CAPSULE [ZOKINVY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2467592",
  "drug_name" : "LONAFARNIB 75 MG ORAL CAPSULE [ZOKINVY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2471100",
  "drug_name" : "TIRBANIBULIN 0.01 MG\\/MG TOPICAL OINTMENT [KLISYRI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2471878",
  "drug_name" : "BETAMETHASONE DIPROPIONATE 0.64 MG\\/ML \\/ CALCIPOTRIENE 0.05 MG\\/ML TOPICAL CREAM [WYNZORA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2472332",
  "drug_name" : "10 ML RITUXIMAB-ARRX 10 MG\\/ML INJECTION [RIABNI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2472336",
  "drug_name" : "50 ML RITUXIMAB-ARRX 10 MG\\/ML INJECTION [RIABNI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2472789",
  "drug_name" : "RELUGOLIX 120 MG ORAL TABLET [ORGOVYX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2472794",
  "drug_name" : "TRASTUZUMAB-QYYP 150 MG INJECTION [TRAZIMERA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2473042",
  "drug_name" : "PONATINIB 10 MG ORAL TABLET [ICLUSIG]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2474033",
  "drug_name" : "10 ML MARGETUXIMAB-CMKB 25 MG\\/ML INJECTION [MARGENZA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2474244",
  "drug_name" : "10 ML NAXITAMAB-GQGK 4 MG\\/ML INJECTION [DANYELZA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2475205",
  "drug_name" : "CABOTEGRAVIR 30 MG ORAL TABLET [VOCABRIA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2475416",
  "drug_name" : "CABENUVA 600 MG \\/ 900 MG EXTENDED RELEASE KIT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2475418",
  "drug_name" : "CABENUVA 400 MG \\/ 600 MG EXTENDED RELEASE KIT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2475840",
  "drug_name" : "MANNITOL 40 MG INHALATION POWDER [BRONCHITOL]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2475852",
  "drug_name" : "VERICIGUAT 10 MG ORAL TABLET [VERQUVO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2477272",
  "drug_name" : "TEPOTINIB 225 MG ORAL TABLET [TEPMETKO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2478437",
  "drug_name" : "TOFACITINIB 1 MG\\/ML ORAL SOLUTION [XELJANZ]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2478650",
  "drug_name" : "2.3 ML EVINACUMAB-DGNB 150 MG\\/ML INJECTION [EVKEEZA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2478732",
  "drug_name" : "8 ML EVINACUMAB-DGNB 150 MG\\/ML INJECTION [EVKEEZA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2479710",
  "drug_name" : "TRILACICLIB 300 MG INJECTION [COSELA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2480105",
  "drug_name" : "2 ML CASIMERSEN 50 MG\\/ML INJECTION [AMONDYS 45]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "248109",
  "drug_name" : "RIBAVIRIN 200 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "248420",
  "drug_name" : "MESALAMINE 1000 MG RECTAL SUPPOSITORY",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "248478",
  "drug_name" : "84 HR ESTRADIOL 0.00104 MG\\/HR TRANSDERMAL SYSTEM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "248642",
  "drug_name" : "FLUOXETINE 20 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "248656",
  "drug_name" : "AZITHROMYCIN 500 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "249364",
  "drug_name" : "20 ML CYTARABINE 100 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "250820",
  "drug_name" : "VIGABATRIN 500 MG POWDER FOR ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "251201",
  "drug_name" : "SERTRALINE 200 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "251322",
  "drug_name" : "ETHOSUXIMIDE 50 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "251872",
  "drug_name" : "PANTOPRAZOLE 20 MG DELAYED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "252478",
  "drug_name" : "LAMOTRIGINE 50 MG DISINTEGRATING ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "252479",
  "drug_name" : "LAMOTRIGINE 200 MG DISINTEGRATING ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "252559",
  "drug_name" : "BUDESONIDE 0.5 MG\\/ML INHALATION SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "253113",
  "drug_name" : "10 ML BUSULFAN 6 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2531134",
  "drug_name" : "HUMIRA PEN 80 MG\\/0.8 ML - STARTER PACKAGE FOR PEDIATRIC ULCERATIVE COLITIS (4 COUNT)",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2531297",
  "drug_name" : "FOSDENOPTERIN 9.5 MG INJECTION [NULIBRY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2532159",
  "drug_name" : "PMDD FLUOXETINE 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2532163",
  "drug_name" : "PMDD FLUOXETINE 20 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2532366",
  "drug_name" : "ORITAVANCIN 1200 MG INJECTION [KIMYRSA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2534244",
  "drug_name" : "TIVOZANIB 0.89 MG ORAL CAPSULE [FOTIVDA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2534249",
  "drug_name" : "TIVOZANIB 1.34 MG ORAL CAPSULE [FOTIVDA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2539977",
  "drug_name" : "10 ML DOSTARLIMAB-GXLY 50 MG\\/ML INJECTION [JEMPERLI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2540432",
  "drug_name" : "XCOPRI 250 MG MAINTENANCE PACK - 100 MG (28), 150 MG (28) 56 COUNT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2540695",
  "drug_name" : "1 ML RISANKIZUMAB-RZAA 150 MG\\/ML AUTO-INJECTOR [SKYRIZI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2540699",
  "drug_name" : "1 ML RISANKIZUMAB-RZAA 150 MG\\/ML PREFILLED SYRINGE [SKYRIZI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2540974",
  "drug_name" : "LONCASTUXIMAB TESIRINE-LPYL 10 MG INJECTION [ZYNLONTA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2541513",
  "drug_name" : "VALBENAZINE 60 MG ORAL CAPSULE [INGREZZA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2548736",
  "drug_name" : "XPOVIO 60 MG WEEKLY DOSE CARTON PACK, 4 BLISTER CARDS, 1 TABLET EACH",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2548742",
  "drug_name" : "XPOVIO 100 MG WEEKLY DOSE CARTON PACK, 4 BLISTER CARDS, 2 TABLETS EACH",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2548766",
  "drug_name" : "XPOVIO 80 MG WEEKLY DOSE CARTON PACK, 4 BLISTER CARDS, 2 TABLETS EACH",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2548767",
  "drug_name" : "XPOVIO 40 MG TWICE WEEKLY (80 MG TOTAL WEEKLY) DOSE CARTON PACK, 4 BLISTER CARDS, 2 TABLETS EACH",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2548769",
  "drug_name" : "XPOVIO 40 MG WEEKLY DOSE CARTON PACK, 4 BLISTER CARDS, 1 TABLET EACH",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2549333",
  "drug_name" : "0.6 ML PEGFILGRASTIM 10 MG\\/ML INJECTION [NEULASTA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2549739",
  "drug_name" : "7 ML AMIVANTAMAB-VMJW 50 MG\\/ML INJECTION [RYBREVANT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2550713",
  "drug_name" : "0.5 ML SECUKINUMAB 150 MG\\/ML PREFILLED SYRINGE [COSENTYX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2550725",
  "drug_name" : "SOTORASIB 120 MG ORAL TABLET [LUMAKRAS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2551012",
  "drug_name" : "TRUSELTIQ 100 MG DAILY DOSE CARTON PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2551207",
  "drug_name" : "TRUSELTIQ 50 MG DAILY DOSE CARTON PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2551212",
  "drug_name" : "TRUSELTIQ 75 MG DAILY DOSE CARTON PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2551217",
  "drug_name" : "TRUSELTIQ 125 MG DAILY DOSE CARTON PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2554805",
  "drug_name" : "THYROGEN KIT (0.9 MG VIAL)",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2557216",
  "drug_name" : "TRIKAFTA 50 MG \\/ 37.5 MG \\/ 25 MG AND 75 MG PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2557910",
  "drug_name" : "GLECAPREVIR 50 MG \\/ PIBRENTASVIR 20 MG ORAL PELLET [MAVYRET]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2559707",
  "drug_name" : "1.14 ML DUPILUMAB 175 MG\\/ML AUTO-INJECTOR [DUPIXENT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2559725",
  "drug_name" : "AVAPRITINIB 25 MG ORAL TABLET [AYVAKIT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2559729",
  "drug_name" : "AVAPRITINIB 50 MG ORAL TABLET [AYVAKIT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2561256",
  "drug_name" : "0.5 ML ASPARAGINASE ERWINIA CHRYSANTHEMI (RECOMBINANT)-RYWN 20 MG\\/ML INJECTION [RYLAZE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2562822",
  "drug_name" : "FINERENONE 10 MG ORAL TABLET [KERENDIA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2562826",
  "drug_name" : "FINERENONE 20 MG ORAL TABLET [KERENDIA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2563971",
  "drug_name" : "3 ML INSULIN GLARGINE-YFGN 100 UNT\\/ML PEN INJECTOR",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2563976",
  "drug_name" : "INSULIN GLARGINE-YFGN 100 UNT\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2564037",
  "drug_name" : "BELUMOSUDIL 200 MG ORAL TABLET [REZUROCK]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2565275",
  "drug_name" : "SELEXIPAG 1.8 MG INJECTION [UPTRAVI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2565286",
  "drug_name" : "2 ML ANIFROLUMAB-FNIA 150 MG\\/ML INJECTION [SAPHNELO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2565823",
  "drug_name" : "AVALGLUCOSIDASE ALFA-NGPT 100 MG INJECTION [NEXVIAZYME]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2566439",
  "drug_name" : "TAYSOFY 1 MG \\/ 20 MCG 28 DAY PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2567237",
  "drug_name" : "BELZUTIFAN 40 MG ORAL TABLET [WELIREG]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2569081",
  "drug_name" : "12 ML NIVOLUMAB 10 MG\\/ML INJECTION [OPDIVO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2569100",
  "drug_name" : "1.3 ML DIFELIKEFALIN 0.05 MG\\/ML INJECTION [KORSUVA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2569480",
  "drug_name" : "3 ML ICATIBANT 10 MG\\/ML PREFILLED SYRINGE [SAJAZIR]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2570398",
  "drug_name" : "OLANZAPINE 5 MG \\/ SAMIDORPHAN 10 MG ORAL TABLET [LYBALVI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2570401",
  "drug_name" : "OLANZAPINE 10 MG \\/ SAMIDORPHAN 10 MG ORAL TABLET [LYBALVI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2570404",
  "drug_name" : "OLANZAPINE 15 MG \\/ SAMIDORPHAN 10 MG ORAL TABLET [LYBALVI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2570407",
  "drug_name" : "OLANZAPINE 20 MG \\/ SAMIDORPHAN 10 MG ORAL TABLET [LYBALVI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2570419",
  "drug_name" : "3.5 ML PALIPERIDONE PALMITATE 312 MG\\/ML PREFILLED SYRINGE [INVEGA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2570421",
  "drug_name" : "5 ML PALIPERIDONE PALMITATE 312 MG\\/ML PREFILLED SYRINGE [INVEGA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2570757",
  "drug_name" : "RUXOLITINIB 15 MG\\/ML TOPICAL CREAM [OPZELURA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2571104",
  "drug_name" : "TISOTUMAB VEDOTIN-TFTV 40 MG INJECTION [TIVDAK]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2571842",
  "drug_name" : "ATOGEPANT 10 MG ORAL TABLET [QULIPTA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2571846",
  "drug_name" : "ATOGEPANT 30 MG ORAL TABLET [QULIPTA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2571850",
  "drug_name" : "ATOGEPANT 60 MG ORAL TABLET [QULIPTA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2572111",
  "drug_name" : "AVACOPAN 10 MG ORAL CAPSULE [TAVNEOS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2572292",
  "drug_name" : "0.4 ML CYCLOSPORINE 0.5 MG\\/ML OPHTHALMIC SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2583635",
  "drug_name" : "0.67 ML DUPILUMAB 150 MG\\/ML PREFILLED SYRINGE [DUPIXENT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2583647",
  "drug_name" : "0.25 ML TICK-BORNE ENCEPHALITIS PURIFIED ANTIGEN 0.0048 MG\\/ML PREFILLED SYRINGE [TICOVAC]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2583650",
  "drug_name" : "0.5 ML TICK-BORNE ENCEPHALITIS PURIFIED ANTIGEN 0.0048 MG\\/ML PREFILLED SYRINGE [TICOVAC]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2584199",
  "drug_name" : "SOFOSBUVIR 150 MG \\/ VELPATASVIR 37.5 MG ORAL PELLET [EPCLUSA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2584201",
  "drug_name" : "SOFOSBUVIR 200 MG \\/ VELPATASVIR 50 MG ORAL PELLET [EPCLUSA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2584326",
  "drug_name" : "ASCIMINIB 20 MG ORAL TABLET [SCEMBLIX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2584330",
  "drug_name" : "ASCIMINIB 40 MG ORAL TABLET [SCEMBLIX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2584356",
  "drug_name" : "BICTEGRAVIR 30 MG \\/ EMTRICITABINE 120 MG \\/ TENOFOVIR ALAFENAMIDE 15 MG ORAL TABLET [BIKTARVY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2584475",
  "drug_name" : "CORTICOTROPIN 80 UNT\\/ML INJECTABLE SOLUTION [CORTROPHIN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2584863",
  "drug_name" : "0.1 ML RANIBIZUMAB 100 MG\\/ML INJECTION [SUSVIMO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2585478",
  "drug_name" : "50 ML LEVETIRACETAM 5 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2585717",
  "drug_name" : "[PENTACEL]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2586079",
  "drug_name" : "MARIBAVIR 200 MG ORAL TABLET [LIVTENCITY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2586427",
  "drug_name" : "TOPIRAMATE 25 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2586868",
  "drug_name" : "SIROLIMUS 100 MG INJECTION [FYARRO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2587057",
  "drug_name" : "[QUADRACEL]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2587070",
  "drug_name" : "1 ML ROPEGINTERFERON ALFA-2B-NJFT 0.5 MG\\/ML PREFILLED SYRINGE [BESREMI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2587729",
  "drug_name" : "20 ML EFGARTIGIMOD ALFA-FCAB 20 MG\\/ML INJECTION [VYVGART]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2587806",
  "drug_name" : "1.91 ML TEZEPELUMAB-EKKO 110 MG\\/ML PREFILLED SYRINGE [TEZSPIRE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2587899",
  "drug_name" : "PAXLOVID 300 MG \\/ 100 MG DOSE PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2588062",
  "drug_name" : "RIVAROXABAN 1 MG\\/ML ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2588240",
  "drug_name" : "1 ML HEPATITIS B SURFACE ANTIGEN (ISOFORM L), RECOMBINANT 0.01 MG\\/ML \\/ HEPATITIS B SURFACE ANTIGEN (ISOFORM M), RECOMBINANT 0.01 MG\\/ML \\/ HEPATITIS B SURFACE ANTIGEN (ISOFORM S), RECOMBINANT 0.01 MG\\/ML INJECTION [PREHEVBRIO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2589384",
  "drug_name" : "1 ML TRALOKINUMAB-LDRM 150 MG\\/ML PREFILLED SYRINGE [ADBRY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2590054",
  "drug_name" : "24 HR UPADACITINIB 30 MG EXTENDED RELEASE ORAL TABLET [RINVOQ]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2590613",
  "drug_name" : "CYCLOSPORINE 1 MG\\/ML OPHTHALMIC SUSPENSION [VERKAZIA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2590643",
  "drug_name" : "EMTRICITABINE 120 MG \\/ TENOFOVIR ALAFENAMIDE 15 MG ORAL TABLET [DESCOVY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2590677",
  "drug_name" : "PEMETREXED 25 MG\\/ML INJECTABLE SOLUTION [PEMFEXY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2590741",
  "drug_name" : "HYDROCORTISONE ACETATE 25 MG \\/ PRAMOXINE HYDROCHLORIDE 18 MG RECTAL SUPPOSITORY",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2590754",
  "drug_name" : "0.5 ML TEBENTAFUSP-TEBN 0.2 MG\\/ML INJECTION [KIMMTRAK]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "259081",
  "drug_name" : "12 HR ASPIRIN 25 MG \\/ DIPYRIDAMOLE 200 MG EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2591425",
  "drug_name" : "22 ML SUTIMLIMAB-JOME 50 MG\\/ML INJECTION [ENJAYMO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2591487",
  "drug_name" : "ABROCITINIB 100 MG ORAL TABLET [CIBINQO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2591512",
  "drug_name" : "TALAZOPARIB 0.5 MG ORAL CAPSULE [TALZENNA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2591521",
  "drug_name" : "TALAZOPARIB 0.75 MG ORAL CAPSULE [TALZENNA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2591594",
  "drug_name" : "0.05 ML FARICIMAB-SVOA 120 MG\\/ML INJECTION [VABYSMO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2591786",
  "drug_name" : "CITALOPRAM 30 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "259255",
  "drug_name" : "ATORVASTATIN 80 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "259306",
  "drug_name" : "ALOSETRON 1 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2593121",
  "drug_name" : "[QUADRACEL]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2593376",
  "drug_name" : "BACLOFEN 5 MG\\/ML ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2593419",
  "drug_name" : "2 ML LANADELUMAB-FLYO 150 MG\\/ML PREFILLED SYRINGE [TAKHZYRO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2594742",
  "drug_name" : "PYRUKYND 20 MG 4-WEEK PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2594744",
  "drug_name" : "PYRUKYND 5 MG 4-WEEK PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2594746",
  "drug_name" : "PYRUKYND 5 MG TAPER PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2594748",
  "drug_name" : "PYRUKYND 5 MG \\/ 20 MG TAPER PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2594750",
  "drug_name" : "PYRUKYND 20 MG \\/ 50 MG TAPER PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2594795",
  "drug_name" : "PYRUKYND 50 MG 4-WEEK PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2595049",
  "drug_name" : "LEUPROLIDE 42 MG PREFILLED SYRINGE [CAMCEVI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2595254",
  "drug_name" : "PACRITINIB 100 MG ORAL CAPSULE [VONJO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2595466",
  "drug_name" : "MERZEE 28 DAY PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2596445",
  "drug_name" : "0.4 ML MEPOLIZUMAB 100 MG\\/ML PREFILLED SYRINGE [NUCALA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2596784",
  "drug_name" : "20 ML NIVOLUMAB-RMBW 12 MG\\/ML \\/ RELATLIMAB-RMBW 4 MG\\/ML INJECTION [OPDUALAG]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2596960",
  "drug_name" : "24 HR UPADACITINIB 45 MG EXTENDED RELEASE ORAL TABLET [RINVOQ]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2597670",
  "drug_name" : "120 ACTUAT BUDESONIDE 0.16 MG\\/ACTUAT \\/ FORMOTEROL FUMARATE 0.0045 MG\\/ACTUAT METERED DOSE INHALER [BREYNA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2597673",
  "drug_name" : "120 ACTUAT BUDESONIDE 0.08 MG\\/ACTUAT \\/ FORMOTEROL FUMARATE 0.0045 MG\\/ACTUAT METERED DOSE INHALER [BREYNA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2598343",
  "drug_name" : "2 ML LABETALOL HYDROCHLORIDE 5 MG\\/ML PREFILLED SYRINGE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2598352",
  "drug_name" : "ABACAVIR 60 MG \\/ DOLUTEGRAVIR 5 MG \\/ LAMIVUDINE 30 MG TABLET FOR ORAL SUSPENSION [TRIUMEQ]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2598465",
  "drug_name" : "VIJOICE 125 MG 28 DAY PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2598467",
  "drug_name" : "VIJOICE 50 MG 28 DAY PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2599049",
  "drug_name" : "4 ML BEVACIZUMAB-MALY 25 MG\\/ML INJECTION [ALYMSYS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2599052",
  "drug_name" : "16 ML BEVACIZUMAB-MALY 25 MG\\/ML INJECTION [ALYMSYS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2599365",
  "drug_name" : "3 ML SEMAGLUTIDE 2.68 MG\\/ML PEN INJECTOR [OZEMPIC]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2599543",
  "drug_name" : "PAXLOVID 150 MG \\/ 100 MG DOSE PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "259966",
  "drug_name" : "METHYLPREDNISOLONE 4 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2600878",
  "drug_name" : "MAVACAMTEN 10 MG ORAL CAPSULE [CAMZYOS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2600890",
  "drug_name" : "MAVACAMTEN 5 MG ORAL CAPSULE [CAMZYOS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2601126",
  "drug_name" : "DEXMEDETOMIDINE 0.12 MG SUBLINGUAL FILM [IGALMI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2601131",
  "drug_name" : "DEXMEDETOMIDINE 0.18 MG SUBLINGUAL FILM [IGALMI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2601542",
  "drug_name" : "BORTEZOMIB 1 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2601544",
  "drug_name" : "BORTEZOMIB 2.5 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2601728",
  "drug_name" : "PEMETREXED 1000 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2602122",
  "drug_name" : "EDARAVONE 21 MG\\/ML ORAL SUSPENSION [RADICAVA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2602136",
  "drug_name" : "PEMETREXED 750 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "260218",
  "drug_name" : "MODAFINIL 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2602279",
  "drug_name" : "0.05 ML BROLUCIZUMAB-DBLL 120 MG\\/ML PREFILLED SYRINGE [BEOVU]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2602306",
  "drug_name" : "TAPINAROF 10 MG\\/ML TOPICAL CREAM [VTAMA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2602359",
  "drug_name" : "0.05 ML RANIBIZUMAB-NUNA 10 MG\\/ML INJECTION [BYOOVIZ]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2602363",
  "drug_name" : "20 ML PEMETREXED 25 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  }, {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2602365",
  "drug_name" : "40 ML PEMETREXED 25 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  }, {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2602366",
  "drug_name" : "4 ML PEMETREXED 25 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  }, {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "260243",
  "drug_name" : "PROGESTERONE 100 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "260260",
  "drug_name" : "CARBIDOPA 25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2602754",
  "drug_name" : "TREPROSTINIL 0.016 MG INHALATION POWDER [TYVASO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2602758",
  "drug_name" : "TREPROSTINIL 0.032 MG INHALATION POWDER [TYVASO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2602762",
  "drug_name" : "TREPROSTINIL 0.048 MG INHALATION POWDER [TYVASO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2602766",
  "drug_name" : "TREPROSTINIL 0.064 MG INHALATION POWDER [TYVASO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2602768",
  "drug_name" : "TYVASO DPI 16-32 MCG TITRATION PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2602770",
  "drug_name" : "TYVASO DPI 16-32-48 MCG TITRATION PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2603514",
  "drug_name" : "0.5 ML MEASLES VIRUS VACCINE LIVE, ATTENUATED SCHWARZ STRAIN 5024 UNT\\/ML \\/ MUMPS VIRUS VACCINE LIVE, RIT-4385 STRAIN 31684 UNT\\/ML \\/ RUBELLA VIRUS VACCINE LIVE (WISTAR RA 27-3 STRAIN) 3990 UNT\\/ML INJECTION [PRIORIX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "260376",
  "drug_name" : "TERAZOSIN 10 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2604622",
  "drug_name" : "10 ML RISANKIZUMAB-RZAA 60 MG\\/ML INJECTION [SKYRIZI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2604628",
  "drug_name" : "2.4 ML RISANKIZUMAB-RZAA 150 MG\\/ML CARTRIDGE [SKYRIZI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2604700",
  "drug_name" : "GANAXOLONE 50 MG\\/ML ORAL SUSPENSION [ZTALMY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2604794",
  "drug_name" : "0.5 ML VUTRISIRAN 50 MG\\/ML PREFILLED SYRINGE [AMVUTTRA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2605054",
  "drug_name" : "CARMUSTINE 300 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2605056",
  "drug_name" : "CARMUSTINE 50 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2605341",
  "drug_name" : "34 ML PEMETREXED 25 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2605950",
  "drug_name" : "24 HR VENLAFAXINE 112.5 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2606490",
  "drug_name" : "PIRFENIDONE 534 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2606788",
  "drug_name" : "ZONISAMIDE 20 MG\\/ML ORAL SUSPENSION [ZONISADE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2607531",
  "drug_name" : "LUMATEPERONE 10.5 MG ORAL CAPSULE [CAPLYTA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2607535",
  "drug_name" : "LUMATEPERONE 21 MG ORAL CAPSULE [CAPLYTA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2607737",
  "drug_name" : "ACALABRUTINIB 100 MG ORAL TABLET [CALQUENCE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2608948",
  "drug_name" : "1.4 ML BORTEZOMIB 2.5 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2610416",
  "drug_name" : "OLIPUDASE ALFA-RPCP 20 MG INJECTION [XENPOZYME]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2610428",
  "drug_name" : "7.5 ML SPESOLIMAB-SBZO 60 MG\\/ML INJECTION [SPEVIGO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "261101",
  "drug_name" : "RIFAPENTINE 150 MG ORAL TABLET [PRIFTIN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2611266",
  "drug_name" : "BUPROPION HYDROCHLORIDE 105 MG \\/ DEXTROMETHORPHAN HYDROBROMIDE 45 MG EXTENDED RELEASE ORAL TABLET [AUVELITY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2611460",
  "drug_name" : "IVACAFTOR 94 MG \\/ LUMACAFTOR 75 MG ORAL GRANULES [ORKAMBI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2611540",
  "drug_name" : "IBRUTINIB 70 MG\\/ML ORAL SUSPENSION [IMBRUVICA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "261178",
  "drug_name" : "NYSTATIN 100 UNT\\/MG TOPICAL POWDER [NYSTOP]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2612098",
  "drug_name" : "DEUCRAVACITINIB 6 MG ORAL TABLET [SOTYKTU]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2612547",
  "drug_name" : "0.6 ML EFLAPEGRASTIM-XNST 22 MG\\/ML PREFILLED SYRINGE [ROLVEDON]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2612687",
  "drug_name" : "0.05 ML RANIBIZUMAB-EQRN 10 MG\\/ML INJECTION [CIMERLI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2613759",
  "drug_name" : "1.2 ML RISANKIZUMAB-RZAA 150 MG\\/ML CARTRIDGE [SKYRIZI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2613769",
  "drug_name" : "0.6 ML PEGFILGRASTIM-FPGK 10 MG\\/ML PREFILLED SYRINGE [STIMUFEND]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2618755",
  "drug_name" : "100 ML SODIUM THIOSULFATE 125 MG\\/ML INJECTION [PEDMARK]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2619154",
  "drug_name" : "0.25 MG, 0.5 MG DOSE 3 ML SEMAGLUTIDE 0.68 MG\\/ML PEN INJECTOR [OZEMPIC]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2619323",
  "drug_name" : "15 ML TREMELIMUMAB-ACTL 20 MG\\/ML INJECTION [IMJUDO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2619326",
  "drug_name" : "1.25 ML TREMELIMUMAB-ACTL 20 MG\\/ML INJECTION [IMJUDO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2619438",
  "drug_name" : "3 ML TECLISTAMAB-CQYV 10 MG\\/ML INJECTION [TECVAYLI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2619444",
  "drug_name" : "1.7 ML TECLISTAMAB-CQYV 90 MG\\/ML INJECTION [TECVAYLI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "261962",
  "drug_name" : "RAMIPRIL 10 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2619912",
  "drug_name" : "TRIENTINE HYDROCHLORIDE 500 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2621559",
  "drug_name" : "20 ML MIRVETUXIMAB SORAVTANSINE-GYNX 5 MG\\/ML INJECTION [ELAHERE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2621891",
  "drug_name" : "2 ML TEPLIZUMAB-MZWV 1 MG\\/ML INJECTION [TZIELD]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2622914",
  "drug_name" : "BENDAMUSTINE HYDROCHLORIDE 25 MG\\/ML INJECTABLE SOLUTION [VIVIMUSTA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2623472",
  "drug_name" : "ISAVUCONAZONIUM SULFATE 74.5 MG ORAL CAPSULE [CRESEMBA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2623654",
  "drug_name" : "OLUTASIDENIB 150 MG ORAL CAPSULE [REZLIDHIA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2624724",
  "drug_name" : "PHENOBARBITAL SODIUM 100 MG INJECTION [SEZABY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2625135",
  "drug_name" : "1 ML MOSUNETUZUMAB-AXGB 1 MG\\/ML INJECTION [LUNSUMIO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2625138",
  "drug_name" : "30 ML MOSUNETUZUMAB-AXGB 1 MG\\/ML INJECTION [LUNSUMIO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2625896",
  "drug_name" : "LENACAPAVIR 300 MG ORAL TABLET [SUNLENCA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2625898",
  "drug_name" : "SUNLENCA 4-TABLET PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2625900",
  "drug_name" : "SUNLENCA 5-TABLET PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2625912",
  "drug_name" : "SUNLENCA 927 MG 2-VIAL KIT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2625923",
  "drug_name" : "ADAGRASIB 200 MG ORAL TABLET [KRAZATI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2626359",
  "drug_name" : "6 ML UBLITUXIMAB-XIIY 25 MG\\/ML INJECTION [BRIUMVI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2626387",
  "drug_name" : "OLPRUVA 2 GM PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2626389",
  "drug_name" : "OLPRUVA 3 GM PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2626391",
  "drug_name" : "OLPRUVA 4 GM PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2626393",
  "drug_name" : "OLPRUVA 5 GM PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2626395",
  "drug_name" : "OLPRUVA 6 GM PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2626399",
  "drug_name" : "PEXIDARTINIB 125 MG ORAL CAPSULE [TURALIO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2626401",
  "drug_name" : "OLPRUVA 6.67 GM PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2627656",
  "drug_name" : "4 ML BEVACIZUMAB-ADCD 25 MG\\/ML INJECTION [VEGZELMA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2627659",
  "drug_name" : "16 ML BEVACIZUMAB-ADCD 25 MG\\/ML INJECTION [VEGZELMA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2627781",
  "drug_name" : "METAXALONE 640 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2627825",
  "drug_name" : "ROTAVIRUS VACCINE, LIVE ATTENUATED, G1P[8] HUMAN 89-12 STRAIN 667000 UNT\\/ML ORAL SUSPENSION [ROTARIX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2628204",
  "drug_name" : "LYTGOBI 12 MG DAILY DOSE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2628206",
  "drug_name" : "LYTGOBI 16 MG DAILY DOSE - 4 MG (28)",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2628208",
  "drug_name" : "LYTGOBI 20 MG DAILY DOSE - 4 MG (35)",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2628242",
  "drug_name" : "SOTORASIB 320 MG ORAL TABLET [LUMAKRAS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2628484",
  "drug_name" : "ELACESTRANT 86 MG ORAL TABLET [ORSERDU]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2628489",
  "drug_name" : "ELACESTRANT 345 MG ORAL TABLET [ORSERDU]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2628923",
  "drug_name" : "1.91 ML TEZEPELUMAB-EKKO 110 MG\\/ML AUTO-INJECTOR [TEZSPIRE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2629349",
  "drug_name" : "PIRTOBRUTINIB 100 MG ORAL TABLET [JAYPIRCA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2629353",
  "drug_name" : "PIRTOBRUTINIB 50 MG ORAL TABLET [JAYPIRCA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2629981",
  "drug_name" : "1 ML LANADELUMAB-FLYO 150 MG\\/ML PREFILLED SYRINGE [TAKHZYRO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2630147",
  "drug_name" : "24 HR DEUTETRABENAZINE 12 MG EXTENDED RELEASE ORAL TABLET [AUSTEDO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2630153",
  "drug_name" : "24 HR DEUTETRABENAZINE 24 MG EXTENDED RELEASE ORAL TABLET [AUSTEDO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2630157",
  "drug_name" : "24 HR DEUTETRABENAZINE 6 MG EXTENDED RELEASE ORAL TABLET [AUSTEDO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2630160",
  "drug_name" : "AUSTEDO XR ONCE DAILY, 4 WEEK TITRATION PACK, 6 MG \\/ 12 MG \\/ 24 MG",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2630217",
  "drug_name" : "APALUTAMIDE 240 MG ORAL TABLET [ERLEADA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2630734",
  "drug_name" : "VELMANASE ALFA-TYCV 10 MG INJECTION [LAMZEDE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2630853",
  "drug_name" : "0.1 ML PEGCETACOPLAN 150 MG\\/ML INJECTION [SYFOVRE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2631942",
  "drug_name" : "OMAVELOXOLONE 50 MG ORAL CAPSULE [SKYCLARYS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2632547",
  "drug_name" : "0.6 ML PEGFILGRASTIM-CBQV 10 MG\\/ML AUTO-INJECTOR [UDENYCA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2632556",
  "drug_name" : "DABRAFENIB 10 MG TABLET FOR ORAL SUSPENSION [TAFINLAR]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2632564",
  "drug_name" : "TRAMETINIB 0.05 MG\\/ML ORAL SOLUTION [MEKINIST]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2632863",
  "drug_name" : "TROFINETIDE 200 MG\\/ML ORAL SOLUTION [DAYBUE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2632991",
  "drug_name" : "20 ML RETIFANLIMAB-DLWR 25 MG\\/ML INJECTION [ZYNYZ]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2633021",
  "drug_name" : "LENIOLISIB 70 MG ORAL TABLET [JOENJA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2634359",
  "drug_name" : "OLIPUDASE ALFA-RPCP 4 MG INJECTION [XENPOZYME]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2634479",
  "drug_name" : "0.2 ML ADALIMUMAB-ATTO 50 MG\\/ML PREFILLED SYRINGE [AMJEVITA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2635005",
  "drug_name" : "15 ML TOFERSEN 6.7 MG\\/ML INJECTION [QALSODY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2635022",
  "drug_name" : "TRIKAFTA 80 MG \\/ 40 MG \\/ 60 MG AND 59.5 MG ORAL GRANULES PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2635026",
  "drug_name" : "TRIKAFTA 100 MG \\/ 50 MG \\/ 75 MG AND 75 MG ORAL GRANULES PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2636039",
  "drug_name" : "0.28 ML RISPERIDONE 357 MG\\/ML PREFILLED SYRINGE [UZEDY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2636042",
  "drug_name" : "0.35 ML RISPERIDONE 357 MG\\/ML PREFILLED SYRINGE [UZEDY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2636044",
  "drug_name" : "0.42 ML RISPERIDONE 357 MG\\/ML PREFILLED SYRINGE [UZEDY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2636046",
  "drug_name" : "0.56 ML RISPERIDONE 357 MG\\/ML PREFILLED SYRINGE [UZEDY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2636048",
  "drug_name" : "0.7 ML RISPERIDONE 357 MG\\/ML PREFILLED SYRINGE [UZEDY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2636050",
  "drug_name" : "0.14 ML RISPERIDONE 357 MG\\/ML PREFILLED SYRINGE [UZEDY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2636052",
  "drug_name" : "0.21 ML RISPERIDONE 357 MG\\/ML PREFILLED SYRINGE [UZEDY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2636548",
  "drug_name" : "FECAL MICROBIOTA SPORES, LIVE-BRPK 30000000 UNT ORAL CAPSULE [VOWST]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2636599",
  "drug_name" : "0.5 ML RESPIRATORY SYNCYTIAL VIRUS PRE-FUSION F PROTEIN, RECOMBINANT 0.24 MG\\/ML INJECTION [AREXVY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2636640",
  "drug_name" : "2.4 ML ARIPIPRAZOLE 300 MG\\/ML PREFILLED SYRINGE [ABILIFY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2636646",
  "drug_name" : "3.2 ML ARIPIPRAZOLE 300 MG\\/ML PREFILLED SYRINGE [ABILIFY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2636789",
  "drug_name" : "IVACAFTOR 13.4 MG ORAL GRANULES [KALYDECO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2636793",
  "drug_name" : "IVACAFTOR 5.8 MG ORAL GRANULES [KALYDECO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2637025",
  "drug_name" : "24 HR LACOSAMIDE 100 MG EXTENDED RELEASE ORAL CAPSULE [MOTPOLY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2637030",
  "drug_name" : "24 HR LACOSAMIDE 150 MG EXTENDED RELEASE ORAL CAPSULE [MOTPOLY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2637035",
  "drug_name" : "24 HR LACOSAMIDE 200 MG EXTENDED RELEASE ORAL CAPSULE [MOTPOLY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2637348",
  "drug_name" : "2 ML SECUKINUMAB 150 MG\\/ML AUTO-INJECTOR [COSENTYX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2637405",
  "drug_name" : "0.8 ML EPCORITAMAB-BYSP 60 MG\\/ML INJECTION [EPKINLY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2637411",
  "drug_name" : "0.8 ML EPCORITAMAB-BYSP 5 MG\\/ML INJECTION [EPKINLY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2637462",
  "drug_name" : "10 ML PEGUNIGALSIDASE ALFA-IWXJ 2 MG\\/ML INJECTION [ELFABRIO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2637556",
  "drug_name" : "PERFLUOROHEXYLOCTANE 1340 MG\\/ML OPHTHALMIC SOLUTION [MIEBO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2637767",
  "drug_name" : "BEREMAGENE GEPERPAVEC-SVDT 5000000000 UNT\\/ML TOPICAL SUSPENSION [VYJUVEK]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2637964",
  "drug_name" : "10 ML PEMETREXED 10 MG\\/ML INJECTION [PEMRYDI RTU]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2637969",
  "drug_name" : "50 ML PEMETREXED 10 MG\\/ML INJECTION [PEMRYDI RTU]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2637980",
  "drug_name" : "ZAVEGEPANT 10 MG NASAL SPRAY [ZAVZPRET]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2639027",
  "drug_name" : "0.16 ML BUPRENORPHINE 50 MG\\/ML PREFILLED SYRINGE [BRIXADI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2639030",
  "drug_name" : "0.32 ML BUPRENORPHINE 50 MG\\/ML PREFILLED SYRINGE [BRIXADI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2639032",
  "drug_name" : "0.48 ML BUPRENORPHINE 50 MG\\/ML PREFILLED SYRINGE [BRIXADI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2639034",
  "drug_name" : "0.64 ML BUPRENORPHINE 50 MG\\/ML PREFILLED SYRINGE [BRIXADI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2639039",
  "drug_name" : "0.18 ML BUPRENORPHINE 356 MG\\/ML PREFILLED SYRINGE [BRIXADI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2639042",
  "drug_name" : "0.27 ML BUPRENORPHINE 356 MG\\/ML PREFILLED SYRINGE [BRIXADI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2639044",
  "drug_name" : "0.36 ML BUPRENORPHINE 356 MG\\/ML PREFILLED SYRINGE [BRIXADI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2639165",
  "drug_name" : "REZAFUNGIN 200 MG INJECTION [REZZAYO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2639651",
  "drug_name" : "0.4 ML ADALIMUMAB-AATY 100 MG\\/ML AUTO-INJECTOR",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2639657",
  "drug_name" : "0.4 ML ADALIMUMAB-AATY 100 MG\\/ML AUTO-INJECTOR [YUFLYMA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2639659",
  "drug_name" : "0.4 ML ADALIMUMAB-AATY 100 MG\\/ML PREFILLED SYRINGE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2639662",
  "drug_name" : "0.4 ML ADALIMUMAB-AATY 100 MG\\/ML PREFILLED SYRINGE [YUFLYMA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2639669",
  "drug_name" : "PEDIATRIC 1.5 ML LEUPROLIDE ACETATE 30 MG\\/ML PREFILLED SYRINGE [LUPRON]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2639734",
  "drug_name" : "RISPERIDONE 25 MG INJECTION [RYKINDO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2639736",
  "drug_name" : "RISPERIDONE 37.5 MG INJECTION [RYKINDO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2639738",
  "drug_name" : "RISPERIDONE 50 MG INJECTION [RYKINDO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2639743",
  "drug_name" : "PEDIATRIC 1 ML LEUPROLIDE ACETATE 7.5 MG\\/ML PREFILLED SYRINGE [LUPRON]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2639750",
  "drug_name" : "PEDIATRIC 1.5 ML LEUPROLIDE ACETATE 7.5 MG\\/ML PREFILLED SYRINGE [LUPRON]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2639792",
  "drug_name" : "10 ML GLOFITAMAB-GXBM 1 MG\\/ML INJECTION [COLUMVI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2639795",
  "drug_name" : "2.5 ML GLOFITAMAB-GXBM 1 MG\\/ML INJECTION [COLUMVI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2639941",
  "drug_name" : "CYCLOSPORINE 1 MG\\/ML OPHTHALMIC SOLUTION [VEVYE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2639957",
  "drug_name" : "5.6 ML EFGARTIGIMOD ALFA-QVFC 180 MG\\/ML \\/ HYALURONIDASE-QVFC 2000 UNT\\/ML INJECTION [VYVGART HYTRULO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2639962",
  "drug_name" : "TALAZOPARIB 0.1 MG ORAL CAPSULE [TALZENNA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2639966",
  "drug_name" : "TALAZOPARIB 0.35 MG ORAL CAPSULE [TALZENNA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2640210",
  "drug_name" : "NIRAPARIB 100 MG ORAL TABLET [ZEJULA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2640212",
  "drug_name" : "NIRAPARIB 200 MG ORAL TABLET [ZEJULA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2640214",
  "drug_name" : "NIRAPARIB 300 MG ORAL TABLET [ZEJULA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2640300",
  "drug_name" : "0.8 ML ADALIMUMAB-BWWD 50 MG\\/ML AUTO-INJECTOR [HADLIMA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2640305",
  "drug_name" : "0.8 ML ADALIMUMAB-BWWD 50 MG\\/ML PREFILLED SYRINGE [HADLIMA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2640428",
  "drug_name" : "0.4 ML ADALIMUMAB-BWWD 100 MG\\/ML PREFILLED SYRINGE [HADLIMA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2640432",
  "drug_name" : "0.4 ML ADALIMUMAB-BWWD 100 MG\\/ML AUTO-INJECTOR [HADLIMA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2640857",
  "drug_name" : "0.8 ML ADALIMUMAB-AACF 50 MG\\/ML PREFILLED SYRINGE [IDACIO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2640862",
  "drug_name" : "0.8 ML ADALIMUMAB-AACF 50 MG\\/ML AUTO-INJECTOR [IDACIO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2640865",
  "drug_name" : "IDACIO PEN 40 MG\\/0.8 ML STARTER PACK - PLAQUE PSORIASIS (4 COUNT)",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2640870",
  "drug_name" : "IDACIO PEN 40 MG\\/0.8 ML - STARTER PACKAGE FOR CROHN'S DISEASE OR ULCERATIVE COLITIS (6 COUNT)",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2640883",
  "drug_name" : "0.8 ML ADALIMUMAB-ADBM 50 MG\\/ML PREFILLED SYRINGE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2640891",
  "drug_name" : "0.2 ML ADALIMUMAB-ADBM 50 MG\\/ML PREFILLED SYRINGE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2640893",
  "drug_name" : "0.4 ML ADALIMUMAB-ADBM 50 MG\\/ML PREFILLED SYRINGE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2640895",
  "drug_name" : "0.8 ML ADALIMUMAB-ADBM 50 MG\\/ML AUTO-INJECTOR",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2640900",
  "drug_name" : "{4 (0.8 ML ADALIMUMAB-ADBM 50 MG\\/ML AUTO-INJECTOR) } PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2640902",
  "drug_name" : "{6 (0.8 ML ADALIMUMAB-ADBM 50 MG\\/ML AUTO-INJECTOR) } PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2641607",
  "drug_name" : "RITLECITINIB 50 MG ORAL CAPSULE [LITFULO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2641653",
  "drug_name" : "0.2 ML ADALIMUMAB-ADAZ 100 MG\\/ML PREFILLED SYRINGE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2641655",
  "drug_name" : "0.4 ML ADALIMUMAB-ADAZ 100 MG\\/ML AUTO-INJECTOR",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2641660",
  "drug_name" : "0.4 ML ADALIMUMAB-ADAZ 100 MG\\/ML PREFILLED SYRINGE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2641662",
  "drug_name" : "0.8 ML ADALIMUMAB-ADAZ 100 MG\\/ML AUTO-INJECTOR",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2641669",
  "drug_name" : "HYRIMOZ PEDIATRIC CROHN'S STARTER KIT PATIENT WEIGHT > 40 KG",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2642148",
  "drug_name" : "0.5 ML RESPIRATORY SYNCYTIAL VIRUS PRE-FUSION F PROTEIN, A, RECOMBINANT, STABILIZED 0.12 MG\\/ML \\/ RESPIRATORY SYNCYTIAL VIRUS PRE-FUSION F PROTEIN, B, RECOMBINANT, STABILIZED 0.12 MG\\/ML INJECTION [ABRYSVO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2642214",
  "drug_name" : "ZEPOSIA 28-DAY STARTER KIT (7-DAY STARTER PACK AND 0.92 MG 21 COUNT BOTTLE)",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2642294",
  "drug_name" : "2 ML ROZANOLIXIZUMAB-NOLI 140 MG\\/ML INJECTION [RYSTIGGO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2642344",
  "drug_name" : "LIDOCAINE 0.05 MG\\/MG MEDICATED PATCH [LIDOCAN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2642350",
  "drug_name" : "MIGLUSTAT 100 MG ORAL CAPSULE [YARGESA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2642353",
  "drug_name" : "VIGABATRIN 500 MG ORAL TABLET [VIGADRONE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2643060",
  "drug_name" : "QUIZARTINIB 17.7 MG ORAL TABLET [VANFLYTA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2643064",
  "drug_name" : "QUIZARTINIB 26.5 MG ORAL TABLET [VANFLYTA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2643436",
  "drug_name" : "PALIFERMIN 5.16 MG INJECTION [KEPIVANCE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2644445",
  "drug_name" : "NADOFARAGENE FIRADENOVEC-VNCG 15000000000 VIRAL-PARTICLES\\/ML INTRAVESICAL SUSPENSION [ADSTILADRIN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2644458",
  "drug_name" : "1.5 ML TALQUETAMAB-TGVS 2 MG\\/ML INJECTION [TALVEY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2644464",
  "drug_name" : "1 ML TALQUETAMAB-TGVS 40 MG\\/ML INJECTION [TALVEY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2644512",
  "drug_name" : "LOTILANER 2.5 MG\\/ML OPHTHALMIC SOLUTION [XDEMVY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2644523",
  "drug_name" : "1.2 ML SOMATROGON-GHLA 20 MG\\/ML PEN INJECTOR [NGENLA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2644529",
  "drug_name" : "1.2 ML SOMATROGON-GHLA 50 MG\\/ML PEN INJECTOR [NGENLA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2644891",
  "drug_name" : "1.1 ML ELRANATAMAB-BCMM 40 MG\\/ML INJECTION [ELREXFIO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2644894",
  "drug_name" : "1.9 ML ELRANATAMAB-BCMM 40 MG\\/ML INJECTION [ELREXFIO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2645118",
  "drug_name" : "0.1 ML AVACINCAPTAD PEGOL 20 MG\\/ML INJECTION [IZERVAY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2645250",
  "drug_name" : "ABIRATERONE ACETATE 500 MG \\/ NIRAPARIB 50 MG ORAL TABLET [AKEEGA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2645253",
  "drug_name" : "ABIRATERONE ACETATE 500 MG \\/ NIRAPARIB 100 MG ORAL TABLET [AKEEGA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2663904",
  "drug_name" : "0.2 ML ADALIMUMAB-ATTO 100 MG\\/ML PREFILLED SYRINGE [AMJEVITA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2663907",
  "drug_name" : "0.4 ML ADALIMUMAB-ATTO 100 MG\\/ML PREFILLED SYRINGE [AMJEVITA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2663910",
  "drug_name" : "0.4 ML ADALIMUMAB-ATTO 100 MG\\/ML AUTO-INJECTOR [AMJEVITA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2663915",
  "drug_name" : "0.8 ML ADALIMUMAB-ATTO 100 MG\\/ML AUTO-INJECTOR [AMJEVITA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2663918",
  "drug_name" : "2 ML OMALIZUMAB 150 MG\\/ML PREFILLED SYRINGE [XOLAIR]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2663923",
  "drug_name" : "2 ML OMALIZUMAB 150 MG\\/ML AUTO-INJECTOR [XOLAIR]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2663952",
  "drug_name" : "2 ML POZELIMAB-BBFG 200 MG\\/ML INJECTION [VEOPOZ]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2663966",
  "drug_name" : "PALOVAROTENE 1 MG ORAL CAPSULE [SOHONOS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2663970",
  "drug_name" : "PALOVAROTENE 1.5 MG ORAL CAPSULE [SOHONOS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2663974",
  "drug_name" : "PALOVAROTENE 10 MG ORAL CAPSULE [SOHONOS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2663978",
  "drug_name" : "PALOVAROTENE 2.5 MG ORAL CAPSULE [SOHONOS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2663982",
  "drug_name" : "PALOVAROTENE 5 MG ORAL CAPSULE [SOHONOS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2664906",
  "drug_name" : "MOTIXAFORTIDE 62 MG INJECTION [APHEXDA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2665017",
  "drug_name" : "DURLOBACTAM 1000 MG \\/ SULBACTAM 1000 MG INJECTION [XACDURO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2665216",
  "drug_name" : "MOMELOTINIB 100 MG ORAL TABLET [OJJAARA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2665220",
  "drug_name" : "MOMELOTINIB 150 MG ORAL TABLET [OJJAARA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2665224",
  "drug_name" : "MOMELOTINIB 200 MG ORAL TABLET [OJJAARA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2665275",
  "drug_name" : "POTASSIUM CHLORIDE 10 MEQ POWDER FOR ORAL SOLUTION [POKONZA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2665422",
  "drug_name" : "0.8 ML ADALIMUMAB-ADAZ 50 MG\\/ML AUTO-INJECTOR [HYRIMOZ]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2665426",
  "drug_name" : "0.8 ML ADALIMUMAB-ADAZ 50 MG\\/ML PREFILLED SYRINGE [HYRIMOZ]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2667342",
  "drug_name" : "0.68 ML VEDOLIZUMAB 159 MG\\/ML AUTO-INJECTOR [ENTYVIO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2667423",
  "drug_name" : "5 ML SECUKINUMAB 25 MG\\/ML INJECTION [COSENTYX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2667446",
  "drug_name" : "CIPAGLUCOSIDASE ALFA-ATGA 105 MG INJECTION [POMBILITI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2667941",
  "drug_name" : "BACLOFEN 2 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2667943",
  "drug_name" : "BACLOFEN 2 MG\\/ML ORAL SOLUTION [OZOBAX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2668057",
  "drug_name" : "ETRASIMOD 2 MG ORAL TABLET [VELSIPITY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2668071",
  "drug_name" : "0.8 ML ADALIMUMAB-AFZB 50 MG\\/ML AUTO-INJECTOR [ABRILADA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2668078",
  "drug_name" : "0.8 ML ADALIMUMAB-AFZB 50 MG\\/ML PREFILLED SYRINGE [ABRILADA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2668093",
  "drug_name" : "1 ML BIMEKIZUMAB-BKZX 160 MG\\/ML PREFILLED SYRINGE [BIMZELX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2668096",
  "drug_name" : "0.4 ML ADALIMUMAB-AFZB 50 MG\\/ML PREFILLED SYRINGE [ABRILADA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2668103",
  "drug_name" : "1 ML BIMEKIZUMAB-BKZX 160 MG\\/ML AUTO-INJECTOR [BIMZELX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2668162",
  "drug_name" : "OXAPROZIN 300 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2668168",
  "drug_name" : "OXAPROZIN 300 MG ORAL CAPSULE [COXANTO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2668398",
  "drug_name" : "15 ML MIRIKIZUMAB-MRKZ 20 MG\\/ML INJECTION [OMVOH]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2668410",
  "drug_name" : "1 ML MIRIKIZUMAB-MRKZ 100 MG\\/ML AUTO-INJECTOR [OMVOH]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2668483",
  "drug_name" : "0.2 ML ADALIMUMAB-AATY 100 MG\\/ML PREFILLED SYRINGE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2668484",
  "drug_name" : "0.2 ML ADALIMUMAB-AATY 100 MG\\/ML PREFILLED SYRINGE [YUFLYMA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2668487",
  "drug_name" : "0.8 ML ADALIMUMAB-AATY 100 MG\\/ML AUTO-INJECTOR",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2668488",
  "drug_name" : "0.8 ML ADALIMUMAB-AATY 100 MG\\/ML AUTO-INJECTOR [YUFLYMA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2668490",
  "drug_name" : "YUFLYMA AUTO-INJECTOR 80 MG\\/0.8 ML STARTER PACKAGE FOR CROHN'S DISEASE, ULCERATIVE COLITIS OR HIDRADENITIS SUPPURATIVA (3 COUNT)",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2668599",
  "drug_name" : "ENTRECTINIB 50 MG ORAL PELLET [ROZLYTREK]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2669420",
  "drug_name" : "6 ML TORIPALIMAB-TPZI 40 MG\\/ML INJECTION [LOQTORZI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2669450",
  "drug_name" : "TENAPANOR 20 MG ORAL TABLET [XPHOZAH]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2669454",
  "drug_name" : "TENAPANOR 30 MG ORAL TABLET [XPHOZAH]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2669472",
  "drug_name" : "AMYLASE 252600 UNT \\/ LIPASE 60000 UNT \\/ PROTEASE 189600 UNT DELAYED RELEASE ORAL CAPSULE [ZENPEP]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2669810",
  "drug_name" : "VAMOROLONE 40 MG\\/ML ORAL SUSPENSION [AGAMREE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2669916",
  "drug_name" : "ZURANOLONE 20 MG ORAL CAPSULE [ZURZUVAE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2669920",
  "drug_name" : "ZURANOLONE 25 MG ORAL CAPSULE [ZURZUVAE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2669924",
  "drug_name" : "ZURANOLONE 30 MG ORAL CAPSULE [ZURZUVAE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2669978",
  "drug_name" : "CAPIVASERTIB 160 MG ORAL TABLET [TRUQAP]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2669982",
  "drug_name" : "CAPIVASERTIB 200 MG ORAL TABLET [TRUQAP]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2670170",
  "drug_name" : "CRIZOTINIB 150 MG ORAL PELLET [XALKORI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2670174",
  "drug_name" : "CRIZOTINIB 20 MG ORAL PELLET [XALKORI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2670178",
  "drug_name" : "CRIZOTINIB 50 MG ORAL PELLET [XALKORI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2670190",
  "drug_name" : "FRUQUINTINIB 1 MG ORAL CAPSULE [FRUZAQLA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2670198",
  "drug_name" : "FRUQUINTINIB 5 MG ORAL CAPSULE [FRUZAQLA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2670300",
  "drug_name" : "ADAMTS13, RECOMBINANT-KRHN 1500 UNT INJECTION [ADZYNMA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2670313",
  "drug_name" : "ADAMTS13, RECOMBINANT-KRHN 500 UNT INJECTION [ADZYNMA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2670566",
  "drug_name" : "[PENBRAYA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2670643",
  "drug_name" : "NIROGACESTAT 50 MG ORAL TABLET [OGSIVEO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2670655",
  "drug_name" : "REPOTRECTINIB 40 MG ORAL CAPSULE [AUGTYRO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2670669",
  "drug_name" : "1 ML EFBEMALENOGRASTIM ALFA-VUXW 20 MG\\/ML PREFILLED SYRINGE [RYZNEUTA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2671080",
  "drug_name" : "IPTACOPAN 200 MG ORAL CAPSULE [FABHALTA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2671462",
  "drug_name" : "METHOTREXATE 2 MG\\/ML ORAL SOLUTION [JYLAMVO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2671950",
  "drug_name" : "0.8 ML EPLONTERSEN 56.3 MG\\/ML AUTO-INJECTOR [WAINUA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2672105",
  "drug_name" : "50 ML IMMUNE GLOBULIN INTRAVENOUS (HUMAN) - STWK 100 MG\\/ML INJECTION [ALYGLO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2672108",
  "drug_name" : "100 ML IMMUNE GLOBULIN INTRAVENOUS (HUMAN) - STWK 100 MG\\/ML INJECTION [ALYGLO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2672110",
  "drug_name" : "200 ML IMMUNE GLOBULIN INTRAVENOUS (HUMAN) - STWK 100 MG\\/ML INJECTION [ALYGLO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2672326",
  "drug_name" : "BOSUTINIB 100 MG ORAL CAPSULE [BOSULIF]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2672328",
  "drug_name" : "BOSUTINIB 50 MG ORAL CAPSULE [BOSULIF]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2672502",
  "drug_name" : "0.416 ML ZILUCOPLAN 40 MG\\/ML PREFILLED SYRINGE [ZILBRYSQ]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2672505",
  "drug_name" : "0.574 ML ZILUCOPLAN 40 MG\\/ML PREFILLED SYRINGE [ZILBRYSQ]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2672507",
  "drug_name" : "0.81 ML ZILUCOPLAN 40 MG\\/ML PREFILLED SYRINGE [ZILBRYSQ]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2673088",
  "drug_name" : "1 ML CARBOPROST 0.25 MG\\/ML PREFILLED SYRINGE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2673205",
  "drug_name" : "EFLORNITHINE 192 MG ORAL TABLET [IWILFIN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2673602",
  "drug_name" : "0.6 ML PEGFILGRASTIM-CBQV 10 MG\\/ML INJECTION [UDENYCA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2673761",
  "drug_name" : "1 ML OMALIZUMAB 150 MG\\/ML AUTO-INJECTOR [XOLAIR]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2673763",
  "drug_name" : "0.5 ML OMALIZUMAB 150 MG\\/ML AUTO-INJECTOR [XOLAIR]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2674932",
  "drug_name" : "0.25 ML IXEKIZUMAB 80 MG\\/ML PREFILLED SYRINGE [TALTZ]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2674934",
  "drug_name" : "0.5 ML IXEKIZUMAB 80 MG\\/ML PREFILLED SYRINGE [TALTZ]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2675193",
  "drug_name" : "ELTROMBOPAG 18 MG ORAL TABLET [ALVAIZ]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2675197",
  "drug_name" : "ELTROMBOPAG 36 MG ORAL TABLET [ALVAIZ]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2675201",
  "drug_name" : "ELTROMBOPAG 54 MG ORAL TABLET [ALVAIZ]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2675205",
  "drug_name" : "ELTROMBOPAG 9 MG ORAL TABLET [ALVAIZ]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2675286",
  "drug_name" : "BUDESONIDE 0.2 MG\\/ML ORAL SUSPENSION [EOHILIA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2675309",
  "drug_name" : "0.5 ML NEDOSIRAN 160 MG\\/ML INJECTION [RIVFLOZA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2675315",
  "drug_name" : "0.8 ML NEDOSIRAN 160 MG\\/ML PREFILLED SYRINGE [RIVFLOZA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2675318",
  "drug_name" : "1 ML NEDOSIRAN 160 MG\\/ML PREFILLED SYRINGE [RIVFLOZA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2675565",
  "drug_name" : "RILUZOLE 5 MG\\/ML ORAL SUSPENSION [TEGLUTIK]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2675592",
  "drug_name" : "BIRCH TRITERPENES 0.1 MG\\/MG TOPICAL GEL [FILSUVEZ]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2675749",
  "drug_name" : "1 ML INFLIXIMAB-DYYB 120 MG\\/ML PEN INJECTOR [ZYMFENTRA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2675757",
  "drug_name" : "1 ML INFLIXIMAB-DYYB 120 MG\\/ML PREFILLED SYRINGE [ZYMFENTRA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2676585",
  "drug_name" : "TWICE-DAILY CLINDAMYCIN 0.01 MG\\/MG TOPICAL GEL",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2676760",
  "drug_name" : "2.5 ML PEGUNIGALSIDASE ALFA-IWXJ 2 MG\\/ML INJECTION [ELFABRIO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2677439",
  "drug_name" : "10 ML TISLELIZUMAB-JSGR 10 MG\\/ML INJECTION [TEVIMBRA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2677447",
  "drug_name" : "DICHLORPHENAMIDE 50 MG ORAL TABLET [ORMALVI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2677771",
  "drug_name" : "MACITENTAN 10 MG \\/ TADALAFIL 20 MG ORAL TABLET [OPSYNVI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2677775",
  "drug_name" : "MACITENTAN 10 MG \\/ TADALAFIL 40 MG ORAL TABLET [OPSYNVI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2677780",
  "drug_name" : "0.4 ML ADALIMUMAB-RYVK 100 MG\\/ML AUTO-INJECTOR",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2677787",
  "drug_name" : "0.4 ML ADALIMUMAB-RYVK 100 MG\\/ML AUTO-INJECTOR [SIMLANDI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2677905",
  "drug_name" : "RESMETIROM 100 MG ORAL TABLET [REZDIFFRA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2677909",
  "drug_name" : "RESMETIROM 60 MG ORAL TABLET [REZDIFFRA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2677913",
  "drug_name" : "RESMETIROM 80 MG ORAL TABLET [REZDIFFRA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2678248",
  "drug_name" : "RILPIVIRINE 2.5 MG TABLET FOR ORAL SUSPENSION [EDURANT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2678900",
  "drug_name" : "GIVINOSTAT 8.86 MG\\/ML ORAL SUSPENSION [DUVYZAT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2678943",
  "drug_name" : "SOTATERCEPT-CSRK 45 MG INJECTION [WINREVAIR]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2678947",
  "drug_name" : "SOTATERCEPT-CSRK 60 MG INJECTION [WINREVAIR]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2678949",
  "drug_name" : "WINREVAIR 45 MG, 2 VIAL KIT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2678951",
  "drug_name" : "WINREVAIR 60 MG, 2 VIAL KIT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2678973",
  "drug_name" : "VOYDEYA 200 MG DOSE, 2 BOTTLE KIT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2678975",
  "drug_name" : "VOYDEYA 150 MG DOSE, 2 BOTTLE KIT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2678984",
  "drug_name" : "1 ML SPESOLIMAB-SBZO 150 MG\\/ML PREFILLED SYRINGE [SPEVIGO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2679073",
  "drug_name" : "CYCLOPHOSPHAMIDE 100 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2679311",
  "drug_name" : "VADADUSTAT 300 MG ORAL TABLET [VAFSEO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2679438",
  "drug_name" : "4 ML TOCILIZUMAB-AAZG 20 MG\\/ML INJECTION [TYENNE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2679441",
  "drug_name" : "10 ML TOCILIZUMAB-AAZG 20 MG\\/ML INJECTION [TYENNE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2679443",
  "drug_name" : "20 ML TOCILIZUMAB-AAZG 20 MG\\/ML INJECTION [TYENNE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2679784",
  "drug_name" : "16 ML DOCETAXEL 10 MG\\/ML INJECTION [DOCIVYX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2679786",
  "drug_name" : "2 ML DOCETAXEL 10 MG\\/ML INJECTION [DOCIVYX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2679788",
  "drug_name" : "8 ML DOCETAXEL 10 MG\\/ML INJECTION [DOCIVYX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2679808",
  "drug_name" : "SELPERCATINIB 120 MG ORAL TABLET [RETEVMO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2679812",
  "drug_name" : "SELPERCATINIB 160 MG ORAL TABLET [RETEVMO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2679814",
  "drug_name" : "SELPERCATINIB 40 MG ORAL TABLET [RETEVMO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2679816",
  "drug_name" : "SELPERCATINIB 80 MG ORAL TABLET [RETEVMO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2680140",
  "drug_name" : "VIJOICE 50 MG ORAL GRANULES 28 DAY PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2680280",
  "drug_name" : "ASCIMINIB 100 MG ORAL TABLET [SCEMBLIX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2680294",
  "drug_name" : "10 ML TOCILIZUMAB-BAVI 20 MG\\/ML INJECTION [TOFIDENCE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2680297",
  "drug_name" : "20 ML TOCILIZUMAB-BAVI 20 MG\\/ML INJECTION [TOFIDENCE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2680299",
  "drug_name" : "4 ML TOCILIZUMAB-BAVI 20 MG\\/ML INJECTION [TOFIDENCE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2680364",
  "drug_name" : "OGSIVEO 100 MG TABLET 7-DAY 14 COUNT PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2680370",
  "drug_name" : "OGSIVEO 150 MG TABLET 7-DAY 14 COUNT PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2680732",
  "drug_name" : "1 ML MIRIKIZUMAB-MRKZ 100 MG\\/ML PREFILLED SYRINGE [OMVOH]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2680743",
  "drug_name" : "0.4 ML ADALIMUMAB-ADBM 100 MG\\/ML PREFILLED SYRINGE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2680748",
  "drug_name" : "0.4 ML ADALIMUMAB-ADBM 100 MG\\/ML AUTO-INJECTOR",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2680756",
  "drug_name" : "{4 (0.4 ML ADALIMUMAB-ADBM 100 MG\\/ML AUTO-INJECTOR) } PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2680759",
  "drug_name" : "{6 (0.4 ML ADALIMUMAB-ADBM 100 MG\\/ML AUTO-INJECTOR) } PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2680780",
  "drug_name" : "SPRINKLE VALBENAZINE 40 MG ORAL CAPSULE [INGREZZA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2680782",
  "drug_name" : "SPRINKLE VALBENAZINE 60 MG ORAL CAPSULE [INGREZZA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2680784",
  "drug_name" : "SPRINKLE VALBENAZINE 80 MG ORAL CAPSULE [INGREZZA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2681019",
  "drug_name" : "UPADACITINIB 1 MG\\/ML ORAL SOLUTION [RINVOQ]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2681044",
  "drug_name" : "100 ML EDARAVONE 0.6 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2682430",
  "drug_name" : "OTEZLA 28-DAY 10\\/20 STARTER PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2682445",
  "drug_name" : "TOVORAFENIB 300 MG POWDER FOR ORAL SUSPENSION [OJEMDA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2682570",
  "drug_name" : "DIAZEPAM 5 MG BUCCAL FILM [LIBERVANT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2682573",
  "drug_name" : "DIAZEPAM 10 MG BUCCAL FILM [LIBERVANT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2682577",
  "drug_name" : "DIAZEPAM 12.5 MG BUCCAL FILM [LIBERVANT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2682580",
  "drug_name" : "DIAZEPAM 15 MG BUCCAL FILM [LIBERVANT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2682583",
  "drug_name" : "DIAZEPAM 7.5 MG BUCCAL FILM [LIBERVANT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2682691",
  "drug_name" : "0.4 ML NOGAPENDEKIN ALFA INBAKICEPT-PMLN 1 MG\\/ML INTRAVESICAL SOLUTION [ANKTIVA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2682967",
  "drug_name" : "TARLATAMAB-DLLE 1 MG INJECTION [IMDELLTRA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2682971",
  "drug_name" : "TARLATAMAB-DLLE 10 MG INJECTION [IMDELLTRA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2683285",
  "drug_name" : "24 HR DEUTETRABENAZINE 30 MG EXTENDED RELEASE ORAL TABLET [AUSTEDO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2683291",
  "drug_name" : "24 HR DEUTETRABENAZINE 36 MG EXTENDED RELEASE ORAL TABLET [AUSTEDO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2683297",
  "drug_name" : "24 HR DEUTETRABENAZINE 42 MG EXTENDED RELEASE ORAL TABLET [AUSTEDO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2683303",
  "drug_name" : "24 HR DEUTETRABENAZINE 48 MG EXTENDED RELEASE ORAL TABLET [AUSTEDO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2684032",
  "drug_name" : "MAVORIXAFOR 100 MG ORAL CAPSULE [XOLREMDI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2684851",
  "drug_name" : "MYCOPHENOLATE MOFETIL 200 MG\\/ML ORAL SUSPENSION [MYHIBBIN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2684952",
  "drug_name" : "ELAFIBRANOR 80 MG ORAL TABLET [IQIRVO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2685012",
  "drug_name" : "0.5 ML RESPIRATORY SYNCYTIAL VIRUS PRE-FUSION F GLYCOPROTEIN MRNA 0.1 MG\\/ML PREFILLED SYRINGE [MRESVIA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2685015",
  "drug_name" : "TWICE-DAILY DEFERIPRONE 1000 MG ORAL TABLET [FERRIPROX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2685202",
  "drug_name" : "EVEROLIMUS 2.5 MG ORAL TABLET [TORPENZ]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2685204",
  "drug_name" : "EVEROLIMUS 10 MG ORAL TABLET [TORPENZ]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2685206",
  "drug_name" : "EVEROLIMUS 5 MG ORAL TABLET [TORPENZ]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2685208",
  "drug_name" : "EVEROLIMUS 7.5 MG ORAL TABLET [TORPENZ]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2685223",
  "drug_name" : "VIGABATRIN 100 MG\\/ML ORAL SOLUTION [VIGAFYDE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2685246",
  "drug_name" : "IMETELSTAT 47 MG INJECTION [RYTELO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2685250",
  "drug_name" : "IMETELSTAT 188 MG INJECTION [RYTELO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2685296",
  "drug_name" : "1 ML CORTICOTROPIN 80 UNT\\/ML PREFILLED SYRINGE [ACTHAR]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2685299",
  "drug_name" : "0.5 ML CORTICOTROPIN 80 UNT\\/ML PREFILLED SYRINGE [ACTHAR]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2685615",
  "drug_name" : "3 ML ROZANOLIXIZUMAB-NOLI 140 MG\\/ML INJECTION [RYSTIGGO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2685617",
  "drug_name" : "4 ML ROZANOLIXIZUMAB-NOLI 140 MG\\/ML INJECTION [RYSTIGGO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2685619",
  "drug_name" : "6 ML ROZANOLIXIZUMAB-NOLI 140 MG\\/ML INJECTION [RYSTIGGO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2686050",
  "drug_name" : "0.9 ML TOCILIZUMAB-AAZG 180 MG\\/ML AUTO-INJECTOR [TYENNE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2686057",
  "drug_name" : "0.9 ML TOCILIZUMAB-AAZG 180 MG\\/ML PREFILLED SYRINGE [TYENNE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2686065",
  "drug_name" : "2 ML TRALOKINUMAB-LDRM 150 MG\\/ML AUTO-INJECTOR [ADBRY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2686156",
  "drug_name" : "24 HR DEUTETRABENAZINE 18 MG EXTENDED RELEASE ORAL TABLET [AUSTEDO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2686613",
  "drug_name" : "AUSTEDO XR ONCE DAILY, 4 WEEK TITRATION PACK, 12 MG \\/ 18 MG \\/ 24 MG \\/ 30 MG",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2686633",
  "drug_name" : "2 ML CROVALIMAB-AKKZ 170 MG\\/ML INJECTION [PIASKY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2687207",
  "drug_name" : "SOTORASIB 240 MG ORAL TABLET [LUMAKRAS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2687226",
  "drug_name" : "ENSIFENTRINE 1.2 MG\\/ML INHALATION SUSPENSION [OHTUVAYRE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2688826",
  "drug_name" : "0.4 ML ADALIMUMAB-RYVK 100 MG\\/ML PREFILLED SYRINGE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2688827",
  "drug_name" : "0.4 ML ADALIMUMAB-RYVK 100 MG\\/ML PREFILLED SYRINGE [SIMLANDI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2690659",
  "drug_name" : "VORASIDENIB 10 MG ORAL TABLET [VORANIGO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2690663",
  "drug_name" : "VORASIDENIB 40 MG ORAL TABLET [VORANIGO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2690858",
  "drug_name" : "OJEMDA 400 MG WEEKLY DOSE CARTON PACK, 4 BLISTER CARDS, 4 TABLETS EACH",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2690860",
  "drug_name" : "OJEMDA 500 MG WEEKLY DOSE CARTON PACK, 5 BLISTER CARDS, 4 TABLETS EACH",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2690862",
  "drug_name" : "OJEMDA 600 MG WEEKLY DOSE CARTON PACK, 4 BLISTER CARDS, 6 TABLETS EACH",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2690881",
  "drug_name" : "SELADELPAR 10 MG ORAL CAPSULE [LIVDELZI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2691103",
  "drug_name" : "DIFLUNISAL 375 MG ORAL TABLET [DOLOBID]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2691162",
  "drug_name" : "LAZERTINIB 80 MG ORAL TABLET [LAZCLUZE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2691166",
  "drug_name" : "LAZERTINIB 240 MG ORAL TABLET [LAZCLUZE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2691328",
  "drug_name" : "NEMOLIZUMAB-ILTO 30 MG AUTO-INJECTOR [NEMLUVIO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2692688",
  "drug_name" : "0.05 ML FARICIMAB-SVOA 120 MG\\/ML PREFILLED SYRINGE [VABYSMO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2693092",
  "drug_name" : "20 ML GUSELKUMAB 10 MG\\/ML INJECTION [TREMFYA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2693095",
  "drug_name" : "2 ML GUSELKUMAB 100 MG\\/ML AUTO-INJECTOR [TREMFYA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2693097",
  "drug_name" : "2 ML GUSELKUMAB 100 MG\\/ML PREFILLED SYRINGE [TREMFYA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2693193",
  "drug_name" : "LETERMOVIR 120 MG ORAL PELLET [PREVYMIS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2693465",
  "drug_name" : "23 ML HYALURONIDASE-OCSQ 1000 UNT\\/ML \\/ OCRELIZUMAB-OCSQ 40 MG\\/ML INJECTION [OCREVUS ZUNOVO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2693567",
  "drug_name" : "0.05 ML AFLIBERCEPT 40 MG\\/ML PREFILLED SYRINGE [EYLEA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2693623",
  "drug_name" : "LEVACETYLLEUCINE 1000 MG GRANULES FOR ORAL SUSPENSION [AQNEURSA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2693643",
  "drug_name" : "0.56 ML TERIPARATIDE 0.3 MG\\/ML PEN INJECTOR [YORVIPATH]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2693646",
  "drug_name" : "0.98 ML TERIPARATIDE 0.3 MG\\/ML PEN INJECTOR [YORVIPATH]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2693648",
  "drug_name" : "1.4 ML TERIPARATIDE 0.3 MG\\/ML PEN INJECTOR [YORVIPATH]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2693791",
  "drug_name" : "2 ML LEBRIKIZUMAB-LBKZ 125 MG\\/ML PREFILLED SYRINGE [EBGLYSS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2693899",
  "drug_name" : "15 ML ATEZOLIZUMAB-TQJS 125 MG\\/ML \\/ HYALURONIDASE-TQJS 2000 UNT\\/ML INJECTION [TECENTRIQ HYBREZA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2693907",
  "drug_name" : "2 ML LEBRIKIZUMAB-LBKZ 125 MG\\/ML PEN INJECTOR [EBGLYSS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2693996",
  "drug_name" : "1.4 ML BORTEZOMIB 2.5 MG\\/ML INJECTION [BORUZU]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2694294",
  "drug_name" : "ARIMOCLOMOL 124 MG ORAL CAPSULE [MIPLYFFA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2694298",
  "drug_name" : "ARIMOCLOMOL 47 MG ORAL CAPSULE [MIPLYFFA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2694302",
  "drug_name" : "ARIMOCLOMOL 62 MG ORAL CAPSULE [MIPLYFFA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2694306",
  "drug_name" : "ARIMOCLOMOL 93 MG ORAL CAPSULE [MIPLYFFA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2694850",
  "drug_name" : "TROSPIUM CHLORIDE 20 MG \\/ XANOMELINE 50 MG ORAL CAPSULE [COBENFY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2694855",
  "drug_name" : "TROSPIUM CHLORIDE 30 MG \\/ XANOMELINE 125 MG ORAL CAPSULE [COBENFY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2694991",
  "drug_name" : "TROSPIUM CHLORIDE 20 MG \\/ XANOMELINE 100 MG ORAL CAPSULE [COBENFY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2694993",
  "drug_name" : "COBENFY 28-DAY (50 MG\\/20 MG (4), 100 MG\\/20 MG (52)) STARTER KIT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2695433",
  "drug_name" : "INAVOLISIB 3 MG ORAL TABLET [ITOVEBI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2695437",
  "drug_name" : "INAVOLISIB 9 MG ORAL TABLET [ITOVEBI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2695882",
  "drug_name" : "ZOLBETUXIMAB-CLZB 100 MG INJECTION [VYLOY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2696079",
  "drug_name" : "HYDROXYUREA 100 MG\\/ML ORAL SOLUTION [XROMI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2696255",
  "drug_name" : "NORETHINDRONE ACETATE 5 MG ORAL TABLET [GALLIFREY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2696267",
  "drug_name" : "0.05 ML AFLIBERCEPT-AYYH 40 MG\\/ML PREFILLED SYRINGE [PAVBLU]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2696274",
  "drug_name" : "0.05 ML AFLIBERCEPT-AYYH 40 MG\\/ML INJECTION [PAVBLU]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2696878",
  "drug_name" : "REPOTRECTINIB 160 MG ORAL CAPSULE [AUGTYRO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2697164",
  "drug_name" : "ARIPIPRAZOLE 2 MG ORAL FILM [OPIPZA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2697167",
  "drug_name" : "ARIPIPRAZOLE 5 MG ORAL FILM [OPIPZA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2697170",
  "drug_name" : "ARIPIPRAZOLE 10 MG ORAL FILM [OPIPZA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2698212",
  "drug_name" : "ZANIDATAMAB-HRII 300 MG INJECTION [ZIIHERA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2698324",
  "drug_name" : "ACORAMIDIS 356 MG ORAL TABLET [ATTRUBY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2698337",
  "drug_name" : "REVUMENIB 110 MG ORAL TABLET [REVUFORJ]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2698341",
  "drug_name" : "REVUMENIB 160 MG ORAL TABLET [REVUFORJ]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2698345",
  "drug_name" : "REVUMENIB 25 MG ORAL TABLET [REVUFORJ]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2698570",
  "drug_name" : "NILOTINIB 71 MG ORAL TABLET [DANZITEN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2698574",
  "drug_name" : "NILOTINIB 95 MG ORAL TABLET [DANZITEN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2698763",
  "drug_name" : "SHORTAGE IMPORT UNAPPROVED GLUCOSE 500 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2699122",
  "drug_name" : "2 ML BIMEKIZUMAB-BKZX 160 MG\\/ML AUTO-INJECTOR [BIMZELX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2699124",
  "drug_name" : "2 ML BIMEKIZUMAB-BKZX 160 MG\\/ML PREFILLED SYRINGE [BIMZELX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2699339",
  "drug_name" : "PEMETREXED 100 MG INJECTION [AXTLE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2699341",
  "drug_name" : "PEMETREXED 500 MG INJECTION [AXTLE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2699348",
  "drug_name" : "2.25 ML PALIPERIDONE PALMITATE 156 MG\\/ML PREFILLED SYRINGE [ERZOFRI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2699350",
  "drug_name" : "0.75 ML PALIPERIDONE PALMITATE 156 MG\\/ML PREFILLED SYRINGE [ERZOFRI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2699351",
  "drug_name" : "1 ML PALIPERIDONE PALMITATE 156 MG\\/ML PREFILLED SYRINGE [ERZOFRI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2699352",
  "drug_name" : "1.5 ML PALIPERIDONE PALMITATE 156 MG\\/ML PREFILLED SYRINGE [ERZOFRI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2699354",
  "drug_name" : "0.5 ML PALIPERIDONE PALMITATE 156 MG\\/ML PREFILLED SYRINGE [ERZOFRI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2699601",
  "drug_name" : "18.75 ML ZENOCUTUZUMAB-ZBCO 20 MG\\/ML INJECTION [BIZENGRI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2699618",
  "drug_name" : "TRAZODONE HYDROCHLORIDE 10 MG\\/ML ORAL SOLUTION [RALDESY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2699837",
  "drug_name" : "IMATINIB 80 MG\\/ML ORAL SOLUTION [IMKELDI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2700376",
  "drug_name" : "0.5 ML FILGRASTIM-TXID 0.6 MG\\/ML PREFILLED SYRINGE [NYPOZI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2700379",
  "drug_name" : "0.8 ML FILGRASTIM-TXID 0.6 MG\\/ML PREFILLED SYRINGE [NYPOZI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2700712",
  "drug_name" : "1.5 ML THIOTEPA 10 MG\\/ML INJECTION [TEPYLUTE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2700724",
  "drug_name" : "TRASTUZUMAB-STRF 150 MG INJECTION [HERCESSI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2700731",
  "drug_name" : "TRASTUZUMAB-STRF 21 MG\\/ML INJECTABLE SOLUTION [HERCESSI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2700805",
  "drug_name" : "5 ML HYALURONIDASE-NVHY 2000 UNT\\/ML \\/ NIVOLUMAB-NVHY 120 MG\\/ML INJECTION [OPDIVO QVANTIG]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2701397",
  "drug_name" : "CRINECERFONT 100 MG ORAL CAPSULE [CRENESSITY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2701401",
  "drug_name" : "CRINECERFONT 25 MG ORAL CAPSULE [CRENESSITY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2701405",
  "drug_name" : "CRINECERFONT 50 MG ORAL CAPSULE [CRENESSITY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2701413",
  "drug_name" : "CRINECERFONT 50 MG\\/ML ORAL SOLUTION [CRENESSITY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2701428",
  "drug_name" : "0.8 ML OLEZARSEN 100 MG\\/ML AUTO-INJECTOR [TRYNGOLZA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2701444",
  "drug_name" : "DEUTIVACAFTOR 125 MG \\/ TEZACAFTOR 50 MG \\/ VANZACAFTOR 10 MG ORAL TABLET [ALYFTREK]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2701450",
  "drug_name" : "DEUTIVACAFTOR 50 MG \\/ TEZACAFTOR 20 MG \\/ VANZACAFTOR 4 MG ORAL TABLET [ALYFTREK]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2702682",
  "drug_name" : "TIOPRONIN 100 MG DELAYED RELEASE ORAL TABLET [VENXXIVA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2702684",
  "drug_name" : "TIOPRONIN 300 MG DELAYED RELEASE ORAL TABLET [VENXXIVA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2703024",
  "drug_name" : "0.44 ML AXATILIMAB-CSFR 50 MG\\/ML INJECTION [NIKTIMVO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2703026",
  "drug_name" : "0.18 ML AXATILIMAB-CSFR 50 MG\\/ML INJECTION [NIKTIMVO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2703032",
  "drug_name" : "CYCLOPHOSPHAMIDE 500 MG\\/ML INJECTABLE SOLUTION [FRINDOVYX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2703046",
  "drug_name" : "DATOPOTAMAB DERUXTECAN-DLNK 100 MG INJECTION [DATROWAY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2703052",
  "drug_name" : "OMVOH PREFILLED PEN 300 MG DOSE CARTON - CROHN'S DISEASE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2703054",
  "drug_name" : "OMVOH PREFILLED SYRINGE 300 MG DOSE CARTON - CROHN'S DISEASE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2703567",
  "drug_name" : "CEFTOBIPROLE MEDOCARIL SODIUM 667 MG INJECTION [ZEVTERA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2704987",
  "drug_name" : "PAXLOVID 300 MG \\/ 100 MG ; 150 MG \\/ 100 MG DOSE PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2705360",
  "drug_name" : "AVIBACTAM 500 MG \\/ AZTREONAM 1500 MG INJECTION [EMBLAVEO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2705369",
  "drug_name" : "RISDIPLAM 5 MG ORAL TABLET [EVRYSDI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2705412",
  "drug_name" : "VIMSELTINIB 14 MG ORAL CAPSULE [ROMVIMZA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2705416",
  "drug_name" : "VIMSELTINIB 20 MG ORAL CAPSULE [ROMVIMZA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2705420",
  "drug_name" : "VIMSELTINIB 30 MG ORAL CAPSULE [ROMVIMZA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2705467",
  "drug_name" : "[PENMENVY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2705588",
  "drug_name" : "26 ML USTEKINUMAB-KFCE 5 MG\\/ML INJECTION [YESINTEK]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2705597",
  "drug_name" : "0.5 ML USTEKINUMAB-KFCE 90 MG\\/ML PREFILLED SYRINGE [YESINTEK]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2705600",
  "drug_name" : "1 ML USTEKINUMAB-KFCE 90 MG\\/ML PREFILLED SYRINGE [YESINTEK]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2705603",
  "drug_name" : "0.5 ML USTEKINUMAB-KFCE 90 MG\\/ML INJECTION [YESINTEK]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2705623",
  "drug_name" : "MIRDAMETINIB 1 MG ORAL CAPSULE [GOMEKLI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2705628",
  "drug_name" : "MIRDAMETINIB 2 MG ORAL CAPSULE [GOMEKLI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2705635",
  "drug_name" : "MIRDAMETINIB 1 MG TABLET FOR ORAL SUSPENSION [GOMEKLI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2706378",
  "drug_name" : "24 HR MINOCYCLINE 40 MG EXTENDED RELEASE ORAL CAPSULE [EMROSI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2707132",
  "drug_name" : "0.8 ML CHIKUNGUNYA VIRUS ANTIGEN, RECOMBINANT SENEGAL STRAIN 37997 0.05 MG\\/ML PREFILLED SYRINGE [VIMKUNYA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2707578",
  "drug_name" : "1 ML CORTICOTROPIN 80 UNT\\/ML PREFILLED SYRINGE [CORTROPHIN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2707580",
  "drug_name" : "0.5 ML CORTICOTROPIN 80 UNT\\/ML PREFILLED SYRINGE [CORTROPHIN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2708339",
  "drug_name" : "XPOVIO 40 MG WEEKLY DOSE CARTON PACK, 4 BLISTER CARDS, 4 TABLETS EACH",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2709224",
  "drug_name" : "GEPOTIDACIN 750 MG ORAL TABLET [BLUJEPA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2709442",
  "drug_name" : "THIOTEPA 10 MG\\/ML INJECTABLE SOLUTION [TEPYLUTE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2710426",
  "drug_name" : "COBICISTAT 150 MG \\/ DARUNAVIR 675 MG ORAL TABLET [PREZCOBIX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2710432",
  "drug_name" : "ZOLBETUXIMAB-CLZB 300 MG INJECTION [VYLOY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2710443",
  "drug_name" : "BERDAZIMER 0.103 MG\\/MG TOPICAL GEL [ZELSUVMI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2711556",
  "drug_name" : "24 HR DIAZOXIDE CHOLINE 150 MG EXTENDED RELEASE ORAL TABLET [VYKAT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2711562",
  "drug_name" : "24 HR DIAZOXIDE CHOLINE 25 MG EXTENDED RELEASE ORAL TABLET [VYKAT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2711568",
  "drug_name" : "24 HR DIAZOXIDE CHOLINE 75 MG EXTENDED RELEASE ORAL TABLET [VYKAT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2711638",
  "drug_name" : "TREMFYA INDUCTION PACK FOR CROHN'S DISEASE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2712055",
  "drug_name" : "4 ML BEVACIZUMAB-NWGD 25 MG\\/ML INJECTION [JOBEVNE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2712058",
  "drug_name" : "16 ML BEVACIZUMAB-NWGD 25 MG\\/ML INJECTION [JOBEVNE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2712088",
  "drug_name" : "5 ML EFGARTIGIMOD ALFA-QVFC 200 MG\\/ML \\/ HYALURONIDASE-QVFC 2000 UNT\\/ML PREFILLED SYRINGE [VYVGART HYTRULO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2712234",
  "drug_name" : "THIOTEPA 200 MG INJECTION [TEPADINA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2712467",
  "drug_name" : "MARALIXIBAT 10 MG ORAL TABLET [LIVMARLI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2712471",
  "drug_name" : "MARALIXIBAT 20 MG ORAL TABLET [LIVMARLI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2712475",
  "drug_name" : "MARALIXIBAT 30 MG ORAL TABLET [LIVMARLI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2712479",
  "drug_name" : "MARALIXIBAT 15 MG ORAL TABLET [LIVMARLI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2712640",
  "drug_name" : "ENSARTINIB 100 MG ORAL CAPSULE [ENSACOVE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2712644",
  "drug_name" : "ENSARTINIB 25 MG ORAL CAPSULE [ENSACOVE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2712709",
  "drug_name" : "6.5 ML NIPOCALIMAB-AAHU 185 MG\\/ML INJECTION [IMAAVY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2714180",
  "drug_name" : "BUSPIRONE HYDROCHLORIDE 7.5 MG ORAL CAPSULE [BUCAPSOL]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2714182",
  "drug_name" : "BUSPIRONE HYDROCHLORIDE 10 MG ORAL CAPSULE [BUCAPSOL]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2714184",
  "drug_name" : "BUSPIRONE HYDROCHLORIDE 15 MG ORAL CAPSULE [BUCAPSOL]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2714251",
  "drug_name" : "TELISOTUZUMAB VEDOTIN-TLLV 100 MG INJECTION [EMRELIS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2714255",
  "drug_name" : "TELISOTUZUMAB VEDOTIN-TLLV 20 MG INJECTION [EMRELIS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2714664",
  "drug_name" : "TREPROSTINIL 0.0265 MG INHALATION POWDER [YUTREPIA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2714668",
  "drug_name" : "TREPROSTINIL 0.053 MG INHALATION POWDER [YUTREPIA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2714672",
  "drug_name" : "TREPROSTINIL 0.0795 MG INHALATION POWDER [YUTREPIA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2714676",
  "drug_name" : "TREPROSTINIL 0.106 MG INHALATION POWDER [YUTREPIA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2714922",
  "drug_name" : "AVMAPKI FAKZYNJA CO-PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2715393",
  "drug_name" : "1.7 ML DENOSUMAB-BBDZ 70 MG\\/ML INJECTION [WYOST]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2715459",
  "drug_name" : "NILOTINIB D-TARTRATE 50 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2715469",
  "drug_name" : "NILOTINIB D-TARTRATE 150 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2715473",
  "drug_name" : "NILOTINIB D-TARTRATE 200 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2716556",
  "drug_name" : "HYDROCORTISONE 1 MG\\/ML ORAL SOLUTION [KHINDIVI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2716569",
  "drug_name" : "DEURUXOLITINIB 8 MG ORAL TABLET [LEQSELVI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2716704",
  "drug_name" : "DEFLAZACORT 18 MG ORAL TABLET [JAYTHARI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2716706",
  "drug_name" : "DEFLAZACORT 30 MG ORAL TABLET [JAYTHARI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2716708",
  "drug_name" : "DEFLAZACORT 36 MG ORAL TABLET [JAYTHARI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2716710",
  "drug_name" : "DEFLAZACORT 6 MG ORAL TABLET [JAYTHARI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2716931",
  "drug_name" : "TALETRECTINIB 200 MG ORAL CAPSULE [IBTROZI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2717182",
  "drug_name" : "1.2 ML GARADACIMAB-GXII 167 MG\\/ML AUTO-INJECTOR [ANDEMBRY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2717525",
  "drug_name" : "5 ML COSIBELIMAB-IPDL 60 MG\\/ML INJECTION [UNLOXCYT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2717549",
  "drug_name" : "1.7 ML DENOSUMAB-BNHT 70 MG\\/ML INJECTION [BOMYNTRA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2717555",
  "drug_name" : "1.7 ML DENOSUMAB-BNHT 70 MG\\/ML PREFILLED SYRINGE [BOMYNTRA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2717850",
  "drug_name" : "PROBENECID 500 MG \\/ SULOPENEM ETZADROXIL 500 MG ORAL TABLET [ORLYNVAH]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2717873",
  "drug_name" : "1.7 ML DENOSUMAB-BMWO 70 MG\\/ML INJECTION [OSENVELT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2717955",
  "drug_name" : "SEBETRALSTAT 300 MG ORAL TABLET [EKTERLY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2719223",
  "drug_name" : "ZANUBRUTINIB 160 MG ORAL TABLET [BRUKINSA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2719316",
  "drug_name" : "TESAMORELIN 11.6 MG INJECTION [EGRIFTA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2719335",
  "drug_name" : "TOLVAPTAN 15 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2719337",
  "drug_name" : "TOLVAPTAN 30 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2719470",
  "drug_name" : "DICYCLOMINE HYDROCHLORIDE 40 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2719490",
  "drug_name" : "10 ML LINVOSELTAMAB-GCPT 20 MG\\/ML INJECTION [LYNOZYFIC]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2719497",
  "drug_name" : "2.5 ML LINVOSELTAMAB-GCPT 2 MG\\/ML INJECTION [LYNOZYFIC]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2719722",
  "drug_name" : "NITISINONE 2 MG ORAL TABLET [HARLIKU]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2719763",
  "drug_name" : "GEMCITABINE 38 MG\\/ML INJECTABLE SOLUTION [AVGEMSI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2720345",
  "drug_name" : "0.375 ML LEUPROLIDE ACETATE 60 MG\\/ML PREFILLED SYRINGE [VABRINTY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2720348",
  "drug_name" : "0.375 ML LEUPROLIDE ACETATE 120 MG\\/ML PREFILLED SYRINGE [VABRINTY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2720529",
  "drug_name" : "INSULIN ASPART-XJHZ 100 UNT\\/ML INJECTABLE SOLUTION [KIRSTY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2720541",
  "drug_name" : "3 ML INSULIN ASPART-XJHZ 100 UNT\\/ML PEN INJECTOR [KIRSTY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2721172",
  "drug_name" : "DELGOCITINIB 20 MG\\/ML TOPICAL CREAM [ANZUPGO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2721205",
  "drug_name" : "DORDAVIPRONE 125 MG ORAL CAPSULE [MODEYSO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2721602",
  "drug_name" : "CARBOPLATIN 10 MG\\/ML INJECTABLE SOLUTION [KYXATA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2721615",
  "drug_name" : "ZONGERTINIB 60 MG ORAL TABLET [HERNEXEOS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2721891",
  "drug_name" : "BRENSOCATIB 10 MG ORAL TABLET [BRINSUPRI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2721895",
  "drug_name" : "BRENSOCATIB 25 MG ORAL TABLET [BRINSUPRI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2722409",
  "drug_name" : "RILZABRUTINIB 400 MG ORAL TABLET [WAYRILZ]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2723067",
  "drug_name" : "SEPIAPTERIN 1000 MG ORAL POWDER [SEPHIENCE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "2723071",
  "drug_name" : "SEPIAPTERIN 250 MG ORAL POWDER [SEPHIENCE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "282401",
  "drug_name" : "LAMOTRIGINE 25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "282485",
  "drug_name" : "2 ML DROPERIDOL 2.5 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "283077",
  "drug_name" : "PREDNISOLONE 3 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "283406",
  "drug_name" : "MIRTAZAPINE 15 MG DISINTEGRATING ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "283407",
  "drug_name" : "MIRTAZAPINE 30 MG DISINTEGRATING ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "283485",
  "drug_name" : "MIRTAZAPINE 45 MG DISINTEGRATING ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "283523",
  "drug_name" : "GABAPENTIN 50 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "283535",
  "drug_name" : "DOXYCYCLINE HYCLATE 20 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "283536",
  "drug_name" : "OXCARBAZEPINE 60 MG\\/ML ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "283639",
  "drug_name" : "OLANZAPINE 20 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "283669",
  "drug_name" : "PANTOPRAZOLE 40 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "283672",
  "drug_name" : "CITALOPRAM 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "283858",
  "drug_name" : "ROPINIROLE 3 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "284008",
  "drug_name" : "TRAVOPROST 0.04 MG\\/ML OPHTHALMIC SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "284191",
  "drug_name" : "FLUOROURACIL 5 MG\\/ML TOPICAL CREAM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "284201",
  "drug_name" : "ZOLMITRIPTAN 2.5 MG DISINTEGRATING ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "284215",
  "drug_name" : "CLINDAMYCIN 300 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "284245",
  "drug_name" : "FAMOTIDINE 40 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "284254",
  "drug_name" : "PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY [COMPRO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "284478",
  "drug_name" : "MIFEPRISTONE 200 MG ORAL TABLET [MIFEPREX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "284496",
  "drug_name" : "TAZAROTENE 0.5 MG\\/ML TOPICAL CREAM [TAZORAC]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "284539",
  "drug_name" : "FLUOROURACIL 5 MG\\/ML TOPICAL CREAM [CARAC]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "284592",
  "drug_name" : "METHOTREXATE 5 MG ORAL TABLET [TREXALL]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "284593",
  "drug_name" : "METHOTREXATE 10 MG ORAL TABLET [TREXALL]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "284594",
  "drug_name" : "METHOTREXATE 7.5 MG ORAL TABLET [TREXALL]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "284595",
  "drug_name" : "METHOTREXATE 15 MG ORAL TABLET [TREXALL]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "285028",
  "drug_name" : "ABACAVIR 300 MG \\/ LAMIVUDINE 150 MG \\/ ZIDOVUDINE 300 MG ORAL TABLET [TRIZIVIR]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "307702",
  "drug_name" : "ACETAZOLAMIDE 500 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "307707",
  "drug_name" : "ACETIC ACID 2.5 MG\\/ML IRRIGATION SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "307718",
  "drug_name" : "ACETYLCYSTEINE 100 MG\\/ML INHALATION SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "307719",
  "drug_name" : "ACETYLCYSTEINE 200 MG\\/ML INHALATION SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "307730",
  "drug_name" : "ACYCLOVIR 40 MG\\/ML ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "307732",
  "drug_name" : "ADAPALENE 1 MG\\/ML TOPICAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "308047",
  "drug_name" : "ALPRAZOLAM 0.25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "308048",
  "drug_name" : "ALPRAZOLAM 0.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "308135",
  "drug_name" : "AMLODIPINE 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "308136",
  "drug_name" : "AMLODIPINE 2.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "308177",
  "drug_name" : "AMOXICILLIN 125 MG CHEWABLE TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "308182",
  "drug_name" : "AMOXICILLIN 250 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "308189",
  "drug_name" : "AMOXICILLIN 80 MG\\/ML ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "308191",
  "drug_name" : "AMOXICILLIN 500 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "308192",
  "drug_name" : "AMOXICILLIN 500 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "308194",
  "drug_name" : "AMOXICILLIN 875 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "308207",
  "drug_name" : "AMPICILLIN 125 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "308212",
  "drug_name" : "AMPICILLIN 500 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "308345",
  "drug_name" : "APRACLONIDINE 5 MG\\/ML OPHTHALMIC SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "308351",
  "drug_name" : "2.5 ML ARGATROBAN 100 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "308429",
  "drug_name" : "ATOVAQUONE 150 MG\\/ML ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "308459",
  "drug_name" : "AZITHROMYCIN 20 MG\\/ML ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "308460",
  "drug_name" : "AZITHROMYCIN 250 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "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" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "308508",
  "drug_name" : "BACITRACIN 0.5 UNT\\/MG OPHTHALMIC OINTMENT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "308511",
  "drug_name" : "BACITRACIN 0.5 UNT\\/MG \\/ POLYMYXIN B 10 UNT\\/MG OPHTHALMIC OINTMENT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "308714",
  "drug_name" : "BETAMETHASONE 0.5 MG\\/ML \\/ CLOTRIMAZOLE 10 MG\\/ML TOPICAL CREAM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "308720",
  "drug_name" : "BETAXOLOL 5 MG\\/ML OPHTHALMIC SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "308724",
  "drug_name" : "BEXAROTENE 0.01 MG\\/MG TOPICAL GEL",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "308725",
  "drug_name" : "BEXAROTENE 75 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "308739",
  "drug_name" : "BIMATOPROST 0.3 MG\\/ML OPHTHALMIC SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "308865",
  "drug_name" : "CALCIPOTRIENE 0.05 MG\\/ML TOPICAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "308866",
  "drug_name" : "SALMON CALCITONIN 200 UNT\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "308867",
  "drug_name" : "CALCITRIOL 0.00025 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "308868",
  "drug_name" : "CALCITRIOL 0.0005 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "308869",
  "drug_name" : "1 ML CALCITRIOL 0.001 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "308962",
  "drug_name" : "CAPTOPRIL 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "308963",
  "drug_name" : "CAPTOPRIL 12.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "308964",
  "drug_name" : "CAPTOPRIL 50 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "308973",
  "drug_name" : "CARBAMAZEPINE 100 MG CHEWABLE TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "308976",
  "drug_name" : "CARBAMAZEPINE 20 MG\\/ML ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "308977",
  "drug_name" : "12 HR CARBAMAZEPINE 200 MG EXTENDED RELEASE ORAL CAPSULE [CARBATROL]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "308979",
  "drug_name" : "CARBAMAZEPINE 200 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "308988",
  "drug_name" : "CARBIDOPA 25 MG \\/ LEVODOPA 100 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "308989",
  "drug_name" : "CARBIDOPA 50 MG \\/ LEVODOPA 200 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "309012",
  "drug_name" : "CARMUSTINE 100 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "309042",
  "drug_name" : "CEFACLOR 75 MG\\/ML ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "309044",
  "drug_name" : "CEFACLOR 25 MG\\/ML ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "309045",
  "drug_name" : "CEFACLOR 250 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "309049",
  "drug_name" : "CEFADROXIL 500 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "309054",
  "drug_name" : "CEFDINIR 25 MG\\/ML ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "309058",
  "drug_name" : "CEFIXIME 20 MG\\/ML ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "309072",
  "drug_name" : "CEFOXITIN 200 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "309076",
  "drug_name" : "CEFPODOXIME 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "309077",
  "drug_name" : "CEFPODOXIME 20 MG\\/ML ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "309078",
  "drug_name" : "CEFPODOXIME 200 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "309079",
  "drug_name" : "CEFPODOXIME 10 MG\\/ML ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "309090",
  "drug_name" : "CEFTRIAXONE 100 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "309092",
  "drug_name" : "CEFTRIAXONE 250 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "309097",
  "drug_name" : "CEFUROXIME 250 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "309098",
  "drug_name" : "CEFUROXIME 500 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "309110",
  "drug_name" : "CEPHALEXIN 25 MG\\/ML ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "309112",
  "drug_name" : "CEPHALEXIN 250 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "309113",
  "drug_name" : "CEPHALEXIN 50 MG\\/ML ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "309114",
  "drug_name" : "CEPHALEXIN 500 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "309289",
  "drug_name" : "CICLOPIROX 7.7 MG\\/ML TOPICAL CREAM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "309291",
  "drug_name" : "CICLOPIROX 80 MG\\/ML TOPICAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "309307",
  "drug_name" : "CIPROFLOXACIN 3 MG\\/ML OPHTHALMIC SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "309309",
  "drug_name" : "CIPROFLOXACIN 500 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "309310",
  "drug_name" : "CIPROFLOXACIN 100 MG\\/ML ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "309311",
  "drug_name" : "CISPLATIN 1 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "309313",
  "drug_name" : "CITALOPRAM 2 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "309314",
  "drug_name" : "CITALOPRAM 40 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "309317",
  "drug_name" : "CITRIC ACID 66.8 MG\\/ML \\/ POTASSIUM CITRATE 110 MG\\/ML \\/ SODIUM CITRATE 100 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "309322",
  "drug_name" : "CLARITHROMYCIN 50 MG\\/ML ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "309329",
  "drug_name" : "CLINDAMYCIN 75 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "309332",
  "drug_name" : "ONCE-DAILY CLINDAMYCIN 0.01 MG\\/MG TOPICAL GEL",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "309333",
  "drug_name" : "CLINDAMYCIN 10 MG\\/ML TOPICAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "309335",
  "drug_name" : "50 ML CLINDAMYCIN 12 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "309336",
  "drug_name" : "50 ML CLINDAMYCIN 18 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "309337",
  "drug_name" : "CLINDAMYCIN 20 MG\\/ML VAGINAL CREAM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "309339",
  "drug_name" : "50 ML CLINDAMYCIN 6 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "309362",
  "drug_name" : "CLOPIDOGREL 75 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "309367",
  "drug_name" : "CLOTRIMAZOLE 10 MG\\/ML TOPICAL CREAM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "309371",
  "drug_name" : "CLOTRIMAZOLE 10 MG ORAL LOZENGE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "309374",
  "drug_name" : "CLOZAPINE 200 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "309650",
  "drug_name" : "4 ML DAUNORUBICIN 5 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "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" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "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" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "309683",
  "drug_name" : "DEXAMETHASONE 1 MG\\/ML \\/ TOBRAMYCIN 3 MG\\/ML OPHTHALMIC SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "309684",
  "drug_name" : "DEXAMETHASONE 1 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "309686",
  "drug_name" : "DEXAMETHASONE 0.1 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "309696",
  "drug_name" : "DEXAMETHASONE PHOSPHATE 10 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "309783",
  "drug_name" : "1000 ML GLUCOSE 50 MG\\/ML \\/ POTASSIUM CHLORIDE 0.02 MEQ\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "309843",
  "drug_name" : "DIAZEPAM 1 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "309844",
  "drug_name" : "DIAZEPAM 5 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "309845",
  "drug_name" : "DIAZEPAM 5 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "309914",
  "drug_name" : "DIMENHYDRINATE 50 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "309952",
  "drug_name" : "DIPYRIDAMOLE 25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "309955",
  "drug_name" : "DIPYRIDAMOLE 75 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "309958",
  "drug_name" : "DISOPYRAMIDE 100 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "309960",
  "drug_name" : "DISOPYRAMIDE 150 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "309985",
  "drug_name" : "250 ML DOBUTAMINE 1 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "309986",
  "drug_name" : "250 ML DOBUTAMINE 2 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310003",
  "drug_name" : "DOFETILIDE 0.125 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310004",
  "drug_name" : "DOFETILIDE 0.25 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310005",
  "drug_name" : "DOFETILIDE 0.5 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310015",
  "drug_name" : "DORZOLAMIDE 20 MG\\/ML OPHTHALMIC SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310027",
  "drug_name" : "DOXYCYCLINE HYCLATE 100 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310149",
  "drug_name" : "ERYTHROMYCIN 0.005 MG\\/MG OPHTHALMIC OINTMENT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310152",
  "drug_name" : "ERYTHROMYCIN 0.02 MG\\/MG TOPICAL GEL",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310154",
  "drug_name" : "ERYTHROMYCIN 250 MG DELAYED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310155",
  "drug_name" : "ERYTHROMYCIN 250 MG DELAYED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310169",
  "drug_name" : "ESTRADIOL 0.1 MG\\/ML VAGINAL CREAM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310170",
  "drug_name" : "168 HR ESTRADIOL 0.00104 MG\\/HR TRANSDERMAL SYSTEM [CLIMARA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310174",
  "drug_name" : "168 HR ESTRADIOL 0.00208 MG\\/HR TRANSDERMAL SYSTEM [CLIMARA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310178",
  "drug_name" : "168 HR ESTRADIOL 0.00312 MG\\/HR TRANSDERMAL SYSTEM [CLIMARA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310181",
  "drug_name" : "168 HR ESTRADIOL 0.00417 MG\\/HR TRANSDERMAL SYSTEM [CLIMARA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310190",
  "drug_name" : "ESTRADIOL VALERATE 20 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310191",
  "drug_name" : "ESTRADIOL VALERATE 40 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310248",
  "drug_name" : "ETOPOSIDE 20 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310261",
  "drug_name" : "EXEMESTANE 25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310273",
  "drug_name" : "FAMOTIDINE 20 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310274",
  "drug_name" : "FAMOTIDINE 8 MG\\/ML ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310285",
  "drug_name" : "FELBAMATE 120 MG\\/ML ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310346",
  "drug_name" : "FINASTERIDE 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310351",
  "drug_name" : "FLOXURIDINE 500 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310352",
  "drug_name" : "FLUCONAZOLE 10 MG\\/ML ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310353",
  "drug_name" : "FLUCONAZOLE 40 MG\\/ML ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310362",
  "drug_name" : "FLUOCINONIDE 0.0005 MG\\/MG TOPICAL GEL",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310364",
  "drug_name" : "FLUOCINONIDE 0.5 MG\\/ML TOPICAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310377",
  "drug_name" : "FLUOROMETHOLONE 1 MG\\/ML OPHTHALMIC SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310379",
  "drug_name" : "FLUOROURACIL 20 MG\\/ML TOPICAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310380",
  "drug_name" : "FLUOROURACIL 50 MG\\/ML TOPICAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310384",
  "drug_name" : "FLUOXETINE 10 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310385",
  "drug_name" : "FLUOXETINE 20 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310386",
  "drug_name" : "FLUOXETINE 4 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310429",
  "drug_name" : "FUROSEMIDE 20 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310430",
  "drug_name" : "GABAPENTIN 100 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310431",
  "drug_name" : "GABAPENTIN 300 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310432",
  "drug_name" : "GABAPENTIN 400 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310433",
  "drug_name" : "GABAPENTIN 600 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310434",
  "drug_name" : "GABAPENTIN 800 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310436",
  "drug_name" : "GALANTAMINE 4 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310437",
  "drug_name" : "GALANTAMINE 8 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310442",
  "drug_name" : "GANCICLOVIR 500 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310459",
  "drug_name" : "GEMFIBROZIL 600 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310465",
  "drug_name" : "GENTAMICIN 0.001 MG\\/MG TOPICAL OINTMENT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310467",
  "drug_name" : "GENTAMICIN 3 MG\\/ML OPHTHALMIC SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310473",
  "drug_name" : "100 ML GENTAMICIN 0.8 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310477",
  "drug_name" : "50 ML GENTAMICIN 1.6 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310488",
  "drug_name" : "GLIPIZIDE 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310489",
  "drug_name" : "24 HR GLIPIZIDE 2.5 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310490",
  "drug_name" : "GLIPIZIDE 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310497",
  "drug_name" : "GLUCAGON (RDNA) 1 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310534",
  "drug_name" : "GLYBURIDE 2.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310537",
  "drug_name" : "GLYBURIDE 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310594",
  "drug_name" : "GRAMICIDIN 0.025 MG\\/ML \\/ NEOMYCIN 1.75 MG\\/ML \\/ POLYMYXIN B 10000 UNT\\/ML OPHTHALMIC SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310599",
  "drug_name" : "GRANISETRON 1 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310600",
  "drug_name" : "GRISEOFULVIN 500 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310670",
  "drug_name" : "HALOPERIDOL 0.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310671",
  "drug_name" : "HALOPERIDOL 1 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310672",
  "drug_name" : "HALOPERIDOL 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "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" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310798",
  "drug_name" : "HYDROCHLOROTHIAZIDE 25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310812",
  "drug_name" : "HYDROCHLOROTHIAZIDE 25 MG \\/ TRIAMTERENE 37.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310818",
  "drug_name" : "HYDROCHLOROTHIAZIDE 50 MG \\/ TRIAMTERENE 75 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310878",
  "drug_name" : "HYDROCORTISONE 1.67 MG\\/ML ENEMA",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310891",
  "drug_name" : "HYDROCORTISONE 25 MG\\/ML TOPICAL CREAM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310982",
  "drug_name" : "IMIQUIMOD 50 MG\\/ML TOPICAL CREAM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310992",
  "drug_name" : "INDOMETHACIN 75 MG EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "310994",
  "drug_name" : "INFLIXIMAB 100 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "311026",
  "drug_name" : "INSULIN ISOPHANE, HUMAN 100 UNT\\/ML INJECTABLE SUSPENSION [HUMULIN N]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "311036",
  "drug_name" : "INSULIN, REGULAR, HUMAN 100 UNT\\/ML INJECTABLE SOLUTION [HUMULIN R]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "311166",
  "drug_name" : "ISONIAZID 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "311192",
  "drug_name" : "ISOSORBIDE MONONITRATE 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "311196",
  "drug_name" : "24 HR ISOSORBIDE MONONITRATE 120 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "311197",
  "drug_name" : "ISOSORBIDE MONONITRATE 20 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "311204",
  "drug_name" : "ITRACONAZOLE 100 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "311207",
  "drug_name" : "IVERMECTIN 3 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "311264",
  "drug_name" : "LAMOTRIGINE 25 MG TABLET FOR ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "311265",
  "drug_name" : "LAMOTRIGINE 5 MG TABLET FOR ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "311288",
  "drug_name" : "LEVETIRACETAM 250 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "311289",
  "drug_name" : "LEVETIRACETAM 500 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "311290",
  "drug_name" : "LEVETIRACETAM 750 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "311296",
  "drug_name" : "LEVOFLOXACIN 750 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "311345",
  "drug_name" : "LINEZOLID 20 MG\\/ML ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "311347",
  "drug_name" : "LINEZOLID 600 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "311353",
  "drug_name" : "LISINOPRIL 2.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "311354",
  "drug_name" : "LISINOPRIL 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "311355",
  "drug_name" : "LITHIUM CARBONATE 150 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "311369",
  "drug_name" : "LOPINAVIR 80 MG\\/ML \\/ RITONAVIR 20 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "311376",
  "drug_name" : "LORAZEPAM 2 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "311385",
  "drug_name" : "LOXAPINE 25 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "311386",
  "drug_name" : "LOXAPINE 5 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "311450",
  "drug_name" : "50 ML MANNITOL 250 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "311486",
  "drug_name" : "MELOXICAM 7.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "311487",
  "drug_name" : "MELPHALAN 50 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "311625",
  "drug_name" : "METHOTREXATE 1000 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "311659",
  "drug_name" : "METHYLPREDNISOLONE 40 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "311666",
  "drug_name" : "METOCLOPRAMIDE 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "311668",
  "drug_name" : "METOCLOPRAMIDE 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "311670",
  "drug_name" : "2 ML METOCLOPRAMIDE 5 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "311671",
  "drug_name" : "METOLAZONE 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "311678",
  "drug_name" : "METRONIDAZOLE 7.5 MG\\/ML TOPICAL CREAM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "311679",
  "drug_name" : "METRONIDAZOLE 0.0075 MG\\/MG TOPICAL GEL",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "311681",
  "drug_name" : "METRONIDAZOLE 500 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "311683",
  "drug_name" : "100 ML METRONIDAZOLE 5 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "311700",
  "drug_name" : "MIDAZOLAM 1 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "311702",
  "drug_name" : "MIDAZOLAM 5 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "311704",
  "drug_name" : "MIFEPRISTONE 200 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "311725",
  "drug_name" : "MIRTAZAPINE 15 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "311726",
  "drug_name" : "MIRTAZAPINE 45 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "311727",
  "drug_name" : "MISOPROSTOL 0.1 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "311753",
  "drug_name" : "MOMETASONE FUROATE 1 MG\\/ML TOPICAL CREAM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "311759",
  "drug_name" : "MONTELUKAST 4 MG CHEWABLE TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "311787",
  "drug_name" : "MOXIFLOXACIN 400 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "311877",
  "drug_name" : "MUPIROCIN 20 MG\\/ML TOPICAL CREAM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "311880",
  "drug_name" : "MYCOPHENOLATE MOFETIL 200 MG\\/ML ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "311881",
  "drug_name" : "MYCOPHENOLATE MOFETIL 500 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "311892",
  "drug_name" : "NABUMETONE 500 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "311893",
  "drug_name" : "NABUMETONE 750 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "311913",
  "drug_name" : "NAPROXEN 25 MG\\/ML ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "311918",
  "drug_name" : "NARATRIPTAN 1 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "311919",
  "drug_name" : "NATEGLINIDE 120 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "311943",
  "drug_name" : "NEVIRAPINE 10 MG\\/ML ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "311944",
  "drug_name" : "NIACIN 500 MG ORAL TABLET [NIACOR]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "311975",
  "drug_name" : "NICOTINE 4 MG CHEWING GUM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "311982",
  "drug_name" : "NILUTAMIDE 150 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "311994",
  "drug_name" : "NITROFURANTOIN, MACROCRYSTALS 25 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "311995",
  "drug_name" : "NITROFURANTOIN, MACROCRYSTALS 50 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312036",
  "drug_name" : "NORTRIPTYLINE 2 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312059",
  "drug_name" : "NYSTATIN 500000 UNT ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312068",
  "drug_name" : "1 ML OCTREOTIDE 0.05 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312069",
  "drug_name" : "1 ML OCTREOTIDE 0.1 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312070",
  "drug_name" : "1 ML OCTREOTIDE 0.5 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312071",
  "drug_name" : "OCTREOTIDE 1 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312075",
  "drug_name" : "OFLOXACIN 3 MG\\/ML OPHTHALMIC SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312076",
  "drug_name" : "OLANZAPINE 10 MG DISINTEGRATING ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312077",
  "drug_name" : "OLANZAPINE 15 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312078",
  "drug_name" : "OLANZAPINE 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312079",
  "drug_name" : "OLANZAPINE 7.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312085",
  "drug_name" : "ONDANSETRON 0.8 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312086",
  "drug_name" : "ONDANSETRON 8 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312087",
  "drug_name" : "ONDANSETRON 8 MG DISINTEGRATING ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312122",
  "drug_name" : "OSELTAMIVIR 75 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312128",
  "drug_name" : "50 ML OXACILLIN 20 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312134",
  "drug_name" : "OXAZEPAM 15 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312136",
  "drug_name" : "OXCARBAZEPINE 150 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312137",
  "drug_name" : "OXCARBAZEPINE 300 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312138",
  "drug_name" : "OXCARBAZEPINE 600 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312199",
  "drug_name" : "PACLITAXEL 6 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312242",
  "drug_name" : "PAROXETINE HYDROCHLORIDE 2 MG\\/ML ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312301",
  "drug_name" : "PENTOXIFYLLINE 400 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312347",
  "drug_name" : "PHENELZINE 15 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312357",
  "drug_name" : "PHENOBARBITAL 15 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312362",
  "drug_name" : "PHENOBARBITAL 30 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312439",
  "drug_name" : "PIMOZIDE 1 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312440",
  "drug_name" : "PIOGLITAZONE 30 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312441",
  "drug_name" : "PIOGLITAZONE 45 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312447",
  "drug_name" : "PIPERACILLIN 200 MG\\/ML \\/ TAZOBACTAM 25 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312504",
  "drug_name" : "POTASSIUM CHLORIDE 10 MEQ EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312507",
  "drug_name" : "100 ML POTASSIUM CHLORIDE 0.1 MEQ\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312515",
  "drug_name" : "POTASSIUM CHLORIDE 1.33 MEQ\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312529",
  "drug_name" : "POTASSIUM CHLORIDE 8 MEQ EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312593",
  "drug_name" : "PRAZOSIN 1 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312594",
  "drug_name" : "PRAZOSIN 2 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312614",
  "drug_name" : "PREDNISOLONE 1 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312615",
  "drug_name" : "PREDNISONE 20 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312617",
  "drug_name" : "PREDNISONE 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312635",
  "drug_name" : "PROCHLORPERAZINE 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312641",
  "drug_name" : "PROGESTERONE 200 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312644",
  "drug_name" : "PROGESTERONE 50 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312743",
  "drug_name" : "QUETIAPINE 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312744",
  "drug_name" : "QUETIAPINE 25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312745",
  "drug_name" : "QUETIAPINE 300 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312817",
  "drug_name" : "RIBAVIRIN 200 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312818",
  "drug_name" : "RIBAVIRIN 20 MG\\/ML INHALATION SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312821",
  "drug_name" : "RIFAMPIN 600 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312828",
  "drug_name" : "RISPERIDONE 0.25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312829",
  "drug_name" : "RISPERIDONE 0.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312830",
  "drug_name" : "RISPERIDONE 1 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312831",
  "drug_name" : "RISPERIDONE 2 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312832",
  "drug_name" : "RISPERIDONE 3 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312835",
  "drug_name" : "RIVASTIGMINE 3 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312836",
  "drug_name" : "RIVASTIGMINE 6 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312837",
  "drug_name" : "RIZATRIPTAN 10 MG DISINTEGRATING ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312839",
  "drug_name" : "RIZATRIPTAN 5 MG DISINTEGRATING ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312840",
  "drug_name" : "RIZATRIPTAN 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312845",
  "drug_name" : "ROPINIROLE 0.25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312846",
  "drug_name" : "ROPINIROLE 0.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312847",
  "drug_name" : "ROPINIROLE 2 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312849",
  "drug_name" : "ROPINIROLE 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312899",
  "drug_name" : "SALSALATE 500 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312938",
  "drug_name" : "SERTRALINE 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312940",
  "drug_name" : "SERTRALINE 25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312941",
  "drug_name" : "SERTRALINE 50 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312961",
  "drug_name" : "SIMVASTATIN 20 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "312962",
  "drug_name" : "SIMVASTATIN 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313016",
  "drug_name" : "SODIUM CHLORIDE 234 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313036",
  "drug_name" : "SODIUM FLUORIDE 1.1 MG CHEWABLE TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313096",
  "drug_name" : "SPIRONOLACTONE 25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313115",
  "drug_name" : "STREPTOMYCIN 1000 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313123",
  "drug_name" : "SUCRALFATE 100 MG\\/ML ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313134",
  "drug_name" : "SULFAMETHOXAZOLE 40 MG\\/ML \\/ TRIMETHOPRIM 8 MG\\/ML ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313142",
  "drug_name" : "SULFASALAZINE 500 MG DELAYED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313159",
  "drug_name" : "SUMATRIPTAN 5 MG\\/ACTUAT NASAL SPRAY",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313160",
  "drug_name" : "SUMATRIPTAN 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313161",
  "drug_name" : "SUMATRIPTAN 50 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313165",
  "drug_name" : "0.5 ML SUMATRIPTAN 12 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313189",
  "drug_name" : "TACROLIMUS 0.0003 MG\\/MG TOPICAL OINTMENT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313190",
  "drug_name" : "TACROLIMUS 0.5 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313195",
  "drug_name" : "TAMOXIFEN 20 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313199",
  "drug_name" : "TAZAROTENE 0.0005 MG\\/MG TOPICAL GEL",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313200",
  "drug_name" : "TAZAROTENE 1 MG\\/ML TOPICAL CREAM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313201",
  "drug_name" : "TAZAROTENE 0.001 MG\\/MG TOPICAL GEL",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313215",
  "drug_name" : "TERAZOSIN 1 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313217",
  "drug_name" : "TERAZOSIN 2 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313219",
  "drug_name" : "TERAZOSIN 5 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313222",
  "drug_name" : "TERBINAFINE 250 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313226",
  "drug_name" : "TERCONAZOLE 4 MG\\/ML VAGINAL CREAM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313291",
  "drug_name" : "THEOPHYLLINE 400 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313306",
  "drug_name" : "THEOPHYLLINE 5.33 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313354",
  "drug_name" : "THIORIDAZINE 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313361",
  "drug_name" : "THIOTHIXENE 10 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313362",
  "drug_name" : "THIOTHIXENE 1 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313364",
  "drug_name" : "THIOTHIXENE 2 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313366",
  "drug_name" : "THIOTHIXENE 5 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313412",
  "drug_name" : "TIZANIDINE 2 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313413",
  "drug_name" : "TIZANIDINE 4 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313415",
  "drug_name" : "TOBRAMYCIN 3 MG\\/ML OPHTHALMIC SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313416",
  "drug_name" : "TOBRAMYCIN 10 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313428",
  "drug_name" : "TOREMIFENE 60 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313447",
  "drug_name" : "TRANYLCYPROMINE 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313450",
  "drug_name" : "TRETINOIN 0.0001 MG\\/MG TOPICAL GEL",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313451",
  "drug_name" : "TRETINOIN 0.00025 MG\\/MG TOPICAL GEL",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313472",
  "drug_name" : "TRIENTINE HYDROCHLORIDE 250 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313477",
  "drug_name" : "TRIFLURIDINE 10 MG\\/ML OPHTHALMIC SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313496",
  "drug_name" : "TRIMIPRAMINE 100 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313498",
  "drug_name" : "TRIMIPRAMINE 25 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313499",
  "drug_name" : "TRIMIPRAMINE 50 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313564",
  "drug_name" : "VALACYCLOVIR 1000 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313565",
  "drug_name" : "VALACYCLOVIR 500 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313566",
  "drug_name" : "VALGANCICLOVIR 450 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313567",
  "drug_name" : "VALRUBICIN 40 MG\\/ML INTRAVESICAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313570",
  "drug_name" : "VANCOMYCIN 125 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313571",
  "drug_name" : "VANCOMYCIN 250 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313572",
  "drug_name" : "VANCOMYCIN 50 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313580",
  "drug_name" : "VENLAFAXINE 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313581",
  "drug_name" : "24 HR VENLAFAXINE 150 MG EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313582",
  "drug_name" : "VENLAFAXINE 25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313583",
  "drug_name" : "24 HR VENLAFAXINE 37.5 MG EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313584",
  "drug_name" : "VENLAFAXINE 37.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313585",
  "drug_name" : "24 HR VENLAFAXINE 75 MG EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313586",
  "drug_name" : "VENLAFAXINE 75 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313761",
  "drug_name" : "ZALEPLON 10 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313762",
  "drug_name" : "ZALEPLON 5 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313776",
  "drug_name" : "ZIPRASIDONE 40 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313777",
  "drug_name" : "ZIPRASIDONE 60 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313778",
  "drug_name" : "ZIPRASIDONE 80 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313786",
  "drug_name" : "ACETIC ACID 20 MG\\/ML \\/ HYDROCORTISONE 10 MG\\/ML OTIC SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313797",
  "drug_name" : "AMOXICILLIN 25 MG\\/ML ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313850",
  "drug_name" : "AMOXICILLIN 40 MG\\/ML ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313888",
  "drug_name" : "CEFACLOR 50 MG\\/ML ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313919",
  "drug_name" : "SALMON CALCITONIN 200 UNT\\/ACTUAT NASAL SPRAY",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313920",
  "drug_name" : "CEFAZOLIN 200 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313921",
  "drug_name" : "CALCIPOTRIENE 0.05 MG\\/ML TOPICAL CREAM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313931",
  "drug_name" : "12 HR CARBAMAZEPINE 300 MG EXTENDED RELEASE ORAL CAPSULE [CARBATROL]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313932",
  "drug_name" : "CALCITRIOL 0.001 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313941",
  "drug_name" : "CICLOPIROX 0.0077 MG\\/MG TOPICAL GEL",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313979",
  "drug_name" : "FLUDROCORTISONE ACETATE 0.1 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313988",
  "drug_name" : "FUROSEMIDE 40 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313989",
  "drug_name" : "FLUOXETINE 40 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313990",
  "drug_name" : "FLUOXETINE 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "313995",
  "drug_name" : "FLUOXETINE 90 MG DELAYED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "314006",
  "drug_name" : "24 HR GLIPIZIDE 5 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "314034",
  "drug_name" : "HALOPERIDOL 2 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "314035",
  "drug_name" : "HALOPERIDOL 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "314055",
  "drug_name" : "ISOSORBIDE DINITRATE 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "314072",
  "drug_name" : "LATANOPROST 0.05 MG\\/ML OPHTHALMIC SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "314075",
  "drug_name" : "LOXAPINE 50 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "314076",
  "drug_name" : "LISINOPRIL 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "314077",
  "drug_name" : "LISINOPRIL 20 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "314078",
  "drug_name" : "LOXAPINE 10 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "314099",
  "drug_name" : "METHYLPREDNISOLONE 62.5 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "314106",
  "drug_name" : "METRONIDAZOLE 250 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "314108",
  "drug_name" : "MINOCYCLINE 75 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "314111",
  "drug_name" : "MIRTAZAPINE 30 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "314119",
  "drug_name" : "NICOTINE 2 MG CHEWING GUM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "314124",
  "drug_name" : "NEOMYCIN 40 MG\\/ML \\/ POLYMYXIN B 200000 UNT\\/ML IRRIGATION SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "314135",
  "drug_name" : "NARATRIPTAN 2.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "314142",
  "drug_name" : "NATEGLINIDE 60 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "314152",
  "drug_name" : "OCTREOTIDE 0.2 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "314154",
  "drug_name" : "OLANZAPINE 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "314155",
  "drug_name" : "OLANZAPINE 5 MG DISINTEGRATING ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "314165",
  "drug_name" : "PREDNISOLONE 10 MG\\/ML OPHTHALMIC SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "314182",
  "drug_name" : "POTASSIUM CHLORIDE 2.67 MEQ\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "314192",
  "drug_name" : "2 ML PROCHLORPERAZINE 5 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "314200",
  "drug_name" : "PANTOPRAZOLE 40 MG DELAYED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "314208",
  "drug_name" : "ROPINIROLE 1 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "314209",
  "drug_name" : "RIZATRIPTAN 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "314211",
  "drug_name" : "RISPERIDONE 4 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "314214",
  "drug_name" : "RIVASTIGMINE 1.5 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "314215",
  "drug_name" : "RIVASTIGMINE 4.5 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "314227",
  "drug_name" : "SUMATRIPTAN 20 MG\\/ACTUAT NASAL SPRAY",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "314230",
  "drug_name" : "SIROLIMUS 1 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "314231",
  "drug_name" : "SIMVASTATIN 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "314234",
  "drug_name" : "SUCRALFATE 1000 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "314241",
  "drug_name" : "THEOPHYLLINE 450 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "314266",
  "drug_name" : "TACROLIMUS 0.001 MG\\/MG TOPICAL OINTMENT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "314277",
  "drug_name" : "VENLAFAXINE 50 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "314285",
  "drug_name" : "ZONISAMIDE 100 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "314286",
  "drug_name" : "ZIPRASIDONE 20 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "315102",
  "drug_name" : "SODIUM FLUORIDE 1.1 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "315107",
  "drug_name" : "24 HR GLIPIZIDE 10 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "315134",
  "drug_name" : "LEVOCARNITINE 100 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "315183",
  "drug_name" : "POTASSIUM CHLORIDE 8 MEQ EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "315187",
  "drug_name" : "PREDNISONE 1 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "315213",
  "drug_name" : "SODIUM FLUORIDE 2.2 MG CHEWABLE TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "315223",
  "drug_name" : "SUMATRIPTAN 25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "317094",
  "drug_name" : "ENTACAPONE 200 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "317110",
  "drug_name" : "24 HR ISOSORBIDE MONONITRATE 30 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "317128",
  "drug_name" : "MISOPROSTOL 0.2 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "317136",
  "drug_name" : "NORTRIPTYLINE 25 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "317173",
  "drug_name" : "CAPTOPRIL 25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "317174",
  "drug_name" : "QUETIAPINE 200 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "317573",
  "drug_name" : "PIOGLITAZONE 15 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "317769",
  "drug_name" : "THEOPHYLLINE 300 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "318179",
  "drug_name" : "ERGOLOID MESYLATES, USP 1 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "318202",
  "drug_name" : "ERYTHROMYCIN 20 MG\\/ML TOPICAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "328160",
  "drug_name" : "CYCLOSPORINE 100 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "328161",
  "drug_name" : "METHYLPREDNISOLONE 16 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "328176",
  "drug_name" : "PRIMIDONE 125 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "343033",
  "drug_name" : "DEXAMETHASONE 0.75 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "346508",
  "drug_name" : "INDOMETHACIN 1 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "346574",
  "drug_name" : "THEOPHYLLINE 200 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "348472",
  "drug_name" : "THEOPHYLLINE 600 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "348506",
  "drug_name" : "ITRACONAZOLE 10 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "348719",
  "drug_name" : "TOBRAMYCIN 60 MG\\/ML INHALATION SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "349094",
  "drug_name" : "BUDESONIDE 0.125 MG\\/ML INHALATION SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "349194",
  "drug_name" : "CLONAZEPAM 0.125 MG DISINTEGRATING ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "349195",
  "drug_name" : "CLONAZEPAM 0.25 MG DISINTEGRATING ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "349196",
  "drug_name" : "CLONAZEPAM 1 MG DISINTEGRATING ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "349197",
  "drug_name" : "CLONAZEPAM 2 MG DISINTEGRATING ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "349198",
  "drug_name" : "CLONAZEPAM 0.5 MG DISINTEGRATING ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "349199",
  "drug_name" : "VALSARTAN 80 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "349200",
  "drug_name" : "VALSARTAN 320 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "349201",
  "drug_name" : "VALSARTAN 160 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "349208",
  "drug_name" : "SIROLIMUS 1 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "349251",
  "drug_name" : "TENOFOVIR DISOPROXIL FUMARATE 300 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "349253",
  "drug_name" : "BOSENTAN 62.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "349287",
  "drug_name" : "FENOFIBRATE 160 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "349332",
  "drug_name" : "ESCITALOPRAM 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "349351",
  "drug_name" : "DESONIDE 0.5 MG\\/ML TOPICAL CREAM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "349353",
  "drug_name" : "HYDROCHLOROTHIAZIDE 25 MG \\/ VALSARTAN 160 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "349407",
  "drug_name" : "TREPROSTINIL 1 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "349408",
  "drug_name" : "TREPROSTINIL 10 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "349409",
  "drug_name" : "TREPROSTINIL 2.5 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "349410",
  "drug_name" : "TREPROSTINIL 5 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "349434",
  "drug_name" : "VORICONAZOLE 200 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "349435",
  "drug_name" : "VORICONAZOLE 50 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "349472",
  "drug_name" : "GEFITINIB 250 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "349477",
  "drug_name" : "EFAVIRENZ 600 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "349482",
  "drug_name" : "SODIUM OXYBATE 500 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "349483",
  "drug_name" : "VALSARTAN 40 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "349490",
  "drug_name" : "ARIPIPRAZOLE 15 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "349491",
  "drug_name" : "LAMIVUDINE 300 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "349514",
  "drug_name" : "CELECOXIB 400 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "349545",
  "drug_name" : "ARIPIPRAZOLE 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "349547",
  "drug_name" : "ARIPIPRAZOLE 30 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "349553",
  "drug_name" : "ARIPIPRAZOLE 20 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "349556",
  "drug_name" : "EZETIMIBE 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "349591",
  "drug_name" : "ATOMOXETINE 10 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "349592",
  "drug_name" : "ATOMOXETINE 18 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "349593",
  "drug_name" : "ATOMOXETINE 25 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "349594",
  "drug_name" : "ATOMOXETINE 40 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "349595",
  "drug_name" : "ATOMOXETINE 60 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "351107",
  "drug_name" : "OLANZAPINE 15 MG DISINTEGRATING ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "351108",
  "drug_name" : "OLANZAPINE 20 MG DISINTEGRATING ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "351109",
  "drug_name" : "BUDESONIDE 0.25 MG\\/ML INHALATION SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "351114",
  "drug_name" : "5 ML ZOLEDRONIC ACID 0.8 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "351133",
  "drug_name" : "FENOFIBRATE 54 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "351134",
  "drug_name" : "ZOLMITRIPTAN 5 MG DISINTEGRATING ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "351136",
  "drug_name" : "ALBUTEROL 0.417 MG\\/ML INHALATION SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "351137",
  "drug_name" : "ALBUTEROL 0.21 MG\\/ML INHALATION SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "351156",
  "drug_name" : "250 ML MOXIFLOXACIN 1.6 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "351172",
  "drug_name" : "DUTASTERIDE 0.5 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "351209",
  "drug_name" : "VORICONAZOLE 200 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "351223",
  "drug_name" : "ZIPRASIDONE 20 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "351246",
  "drug_name" : "MONTELUKAST 4 MG ORAL GRANULES",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "351249",
  "drug_name" : "ESCITALOPRAM 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "351250",
  "drug_name" : "ESCITALOPRAM 20 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "351256",
  "drug_name" : "EPLERENONE 25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "351257",
  "drug_name" : "EPLERENONE 50 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "351264",
  "drug_name" : "BUPRENORPHINE 2 MG SUBLINGUAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "351265",
  "drug_name" : "BUPRENORPHINE 8 MG SUBLINGUAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "351266",
  "drug_name" : "BUPRENORPHINE 2 MG \\/ NALOXONE 0.5 MG SUBLINGUAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "351267",
  "drug_name" : "BUPRENORPHINE 8 MG \\/ NALOXONE 2 MG SUBLINGUAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "351285",
  "drug_name" : "ESCITALOPRAM 1 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "351859",
  "drug_name" : "INSULIN, REGULAR, HUMAN 500 UNT\\/ML INJECTABLE SOLUTION [HUMULIN R]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "352046",
  "drug_name" : "1 ML DARBEPOETIN ALFA 0.06 MG\\/ML INJECTION [ARANESP]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "352047",
  "drug_name" : "1 ML DARBEPOETIN ALFA 0.1 MG\\/ML INJECTION [ARANESP]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "352297",
  "drug_name" : "1 ML PEGINTERFERON ALFA-2A 0.18 MG\\/ML INJECTION [PEGASYS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "353538",
  "drug_name" : "24 HR ISOSORBIDE MONONITRATE 60 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "359228",
  "drug_name" : "AZATHIOPRINE 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "359229",
  "drug_name" : "AZATHIOPRINE 75 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "359296",
  "drug_name" : "CALCIUM ACETATE 667 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "359493",
  "drug_name" : "ELETRIPTAN 20 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "359494",
  "drug_name" : "ELETRIPTAN 40 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "360110",
  "drug_name" : "SIROLIMUS 2 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "381056",
  "drug_name" : "ISOSORBIDE DINITRATE 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "387003",
  "drug_name" : "LEVETIRACETAM 1000 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "387013",
  "drug_name" : "NEBIVOLOL 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "388311",
  "drug_name" : "12 HR CARBAMAZEPINE 100 MG EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "388517",
  "drug_name" : "CALCITRIOL 0.000003 MG\\/MG TOPICAL OINTMENT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "389201",
  "drug_name" : "QUETIAPINE 150 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "389242",
  "drug_name" : "DEFERIPRONE 500 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "391937",
  "drug_name" : "LACTULOSE 667 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "393245",
  "drug_name" : "DIGOXIN 0.05 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "401938",
  "drug_name" : "MIGLUSTAT 100 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "401953",
  "drug_name" : "RISPERIDONE 1 MG DISINTEGRATING ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "401954",
  "drug_name" : "RISPERIDONE 2 MG DISINTEGRATING ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "402010",
  "drug_name" : "RISPERIDONE 25 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "402011",
  "drug_name" : "RISPERIDONE 37.5 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "402012",
  "drug_name" : "RISPERIDONE 50 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "402109",
  "drug_name" : "FOSAMPRENAVIR 700 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "402131",
  "drug_name" : "ARIPIPRAZOLE 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "402243",
  "drug_name" : "BORTEZOMIB 3.5 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  }, {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "402246",
  "drug_name" : "ATAZANAVIR 150 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "402247",
  "drug_name" : "ATAZANAVIR 200 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "402505",
  "drug_name" : "12 HR CARBAMAZEPINE 200 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "402506",
  "drug_name" : "12 HR CARBAMAZEPINE 400 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "402695",
  "drug_name" : "24 HR FELODIPINE 10 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "402696",
  "drug_name" : "24 HR FELODIPINE 5 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "402698",
  "drug_name" : "24 HR FELODIPINE 2.5 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "403810",
  "drug_name" : "APREPITANT 80 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "403811",
  "drug_name" : "APREPITANT 125 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "403818",
  "drug_name" : "MOXIFLOXACIN 5 MG\\/ML OPHTHALMIC SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "403825",
  "drug_name" : "RISPERIDONE 0.5 MG DISINTEGRATING ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "403850",
  "drug_name" : "CARBIDOPA 12.5 MG \\/ ENTACAPONE 200 MG \\/ LEVODOPA 50 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "403851",
  "drug_name" : "CARBIDOPA 25 MG \\/ ENTACAPONE 200 MG \\/ LEVODOPA 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "403852",
  "drug_name" : "CARBIDOPA 37.5 MG \\/ ENTACAPONE 200 MG \\/ LEVODOPA 150 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "403875",
  "drug_name" : "EMTRICITABINE 200 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "403878",
  "drug_name" : "IMATINIB 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "403879",
  "drug_name" : "IMATINIB 400 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "403884",
  "drug_name" : "LEVETIRACETAM 100 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "403908",
  "drug_name" : "CIPROFLOXACIN 3 MG\\/ML \\/ DEXAMETHASONE 1 MG\\/ML OTIC SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "403920",
  "drug_name" : "DAPTOMYCIN 500 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "403930",
  "drug_name" : "ISOTRETINOIN 30 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "403957",
  "drug_name" : "TADALAFIL 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "403966",
  "drug_name" : "ZONISAMIDE 25 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "403967",
  "drug_name" : "ZONISAMIDE 50 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "403969",
  "drug_name" : "FLUOXETINE 25 MG \\/ OLANZAPINE 6 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "403970",
  "drug_name" : "FLUOXETINE 25 MG \\/ OLANZAPINE 12 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "403971",
  "drug_name" : "FLUOXETINE 50 MG \\/ OLANZAPINE 12 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "403972",
  "drug_name" : "FLUOXETINE 50 MG \\/ OLANZAPINE 6 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "403975",
  "drug_name" : "ALOSETRON 0.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "404059",
  "drug_name" : "ISOTRETINOIN 10 MG ORAL CAPSULE [CLARAVIS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "404062",
  "drug_name" : "ISOTRETINOIN 20 MG ORAL CAPSULE [CLARAVIS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "404065",
  "drug_name" : "ISOTRETINOIN 40 MG ORAL CAPSULE [CLARAVIS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "404449",
  "drug_name" : "THALIDOMIDE 100 MG ORAL CAPSULE [THALOMID]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "404450",
  "drug_name" : "THALIDOMIDE 200 MG ORAL CAPSULE [THALOMID]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "404457",
  "drug_name" : "PEGVISOMANT 10 MG INJECTION [SOMAVERT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "404458",
  "drug_name" : "PEGVISOMANT 15 MG INJECTION [SOMAVERT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "404459",
  "drug_name" : "PEGVISOMANT 20 MG INJECTION [SOMAVERT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "404460",
  "drug_name" : "ENFUVIRTIDE 90 MG INJECTION [FUZEON]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "404492",
  "drug_name" : "5 ML LARONIDASE 0.58 MG\\/ML INJECTION [ALDURAZYME]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "404539",
  "drug_name" : "BETAINE 1000 MG POWDER FOR ORAL SOLUTION [CYSTADANE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "404656",
  "drug_name" : "168 HR ESTRADIOL 0.00156 MG\\/HR TRANSDERMAL SYSTEM [CLIMARA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "404657",
  "drug_name" : "168 HR ESTRADIOL 0.0025 MG\\/HR TRANSDERMAL SYSTEM [CLIMARA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "404742",
  "drug_name" : "12 HR CARBAMAZEPINE 100 MG EXTENDED RELEASE ORAL CAPSULE [CARBATROL]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "409823",
  "drug_name" : "CEFIXIME 400 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "410584",
  "drug_name" : "SERTRALINE 150 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "419849",
  "drug_name" : "CEFIXIME 40 MG\\/ML ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "422434",
  "drug_name" : "NITROFURANTOIN 10 MG\\/ML ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "427163",
  "drug_name" : "NITAZOXANIDE 500 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "429212",
  "drug_name" : "CLOZAPINE 50 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "429503",
  "drug_name" : "HYDROCHLOROTHIAZIDE 12.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "430902",
  "drug_name" : "BACLOFEN 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "432400",
  "drug_name" : "CINACALCET 90 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "432401",
  "drug_name" : "CINACALCET 60 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "432402",
  "drug_name" : "CINACALCET 30 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "465355",
  "drug_name" : "VORICONAZOLE 40 MG\\/ML ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "465377",
  "drug_name" : "30 ML ACETYLCYSTEINE 200 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "476177",
  "drug_name" : "CLOZAPINE 100 MG DISINTEGRATING ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "476179",
  "drug_name" : "CLOZAPINE 25 MG DISINTEGRATING ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "476271",
  "drug_name" : "6-AMINOCAPROIC ACID 1000 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "476362",
  "drug_name" : "MESALAMINE 500 MG EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "476556",
  "drug_name" : "EMTRICITABINE 200 MG \\/ TENOFOVIR DISOPROXIL FUMARATE 300 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "476576",
  "drug_name" : "CEFDINIR 50 MG\\/ML ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "476809",
  "drug_name" : "MIRTAZAPINE 7.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "477234",
  "drug_name" : "TINIDAZOLE 250 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "477347",
  "drug_name" : "LANTHANUM CARBONATE 500 MG CHEWABLE TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "477367",
  "drug_name" : "SOLIFENACIN SUCCINATE 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "477372",
  "drug_name" : "SOLIFENACIN SUCCINATE 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "477391",
  "drug_name" : "LEVOFLOXACIN 25 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "483325",
  "drug_name" : "LEVONORGESTREL 1.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "483438",
  "drug_name" : "PREGABALIN 100 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "483440",
  "drug_name" : "PREGABALIN 150 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "483442",
  "drug_name" : "PREGABALIN 25 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "483444",
  "drug_name" : "PREGABALIN 300 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "483446",
  "drug_name" : "PREGABALIN 200 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "483448",
  "drug_name" : "PREGABALIN 50 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "483450",
  "drug_name" : "PREGABALIN 75 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "485020",
  "drug_name" : "MYCOPHENOLIC ACID 180 MG DELAYED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "485023",
  "drug_name" : "MYCOPHENOLIC ACID 360 MG DELAYED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "485246",
  "drug_name" : "AZACITIDINE 100 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "485421",
  "drug_name" : "24 HR DARIFENACIN 15 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "485423",
  "drug_name" : "24 HR DARIFENACIN 7.5 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "485434",
  "drug_name" : "ENTECAVIR 0.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "485436",
  "drug_name" : "ENTECAVIR 1 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "485440",
  "drug_name" : "ESZOPICLONE 1 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "485442",
  "drug_name" : "ESZOPICLONE 2 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "485465",
  "drug_name" : "ESZOPICLONE 3 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "485496",
  "drug_name" : "ARIPIPRAZOLE 1 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "485968",
  "drug_name" : "OLANZAPINE 10 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "486146",
  "drug_name" : "24 HR NITROGLYCERIN 0.6 MG\\/HR TRANSDERMAL SYSTEM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "486148",
  "drug_name" : "24 HR NITROGLYCERIN 0.2 MG\\/HR TRANSDERMAL SYSTEM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "486152",
  "drug_name" : "24 HR NITROGLYCERIN 0.4 MG\\/HR TRANSDERMAL SYSTEM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "486419",
  "drug_name" : "20 ML CLOFARABINE 1 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "486515",
  "drug_name" : "SODIUM CHLORIDE 0.154 MEQ\\/ML IRRIGATION SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "539789",
  "drug_name" : "RIFAXIMIN 200 MG ORAL TABLET [XIFAXAN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "541363",
  "drug_name" : "AMPHETAMINE ASPARTATE 7.5 MG \\/ AMPHETAMINE SULFATE 7.5 MG \\/ DEXTROAMPHETAMINE SACCHARATE 7.5 MG \\/ DEXTROAMPHETAMINE SULFATE 7.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "541524",
  "drug_name" : "METHYLTESTOSTERONE 10 MG ORAL TABLET [METHITEST]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "541878",
  "drug_name" : "AMPHETAMINE ASPARTATE 1.25 MG \\/ AMPHETAMINE SULFATE 1.25 MG \\/ DEXTROAMPHETAMINE SACCHARATE 1.25 MG \\/ DEXTROAMPHETAMINE SULFATE 1.25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "541879",
  "drug_name" : "AMPHETAMINE ASPARTATE 1.25 MG \\/ AMPHETAMINE SULFATE 1.25 MG \\/ DEXTROAMPHETAMINE SACCHARATE 1.25 MG \\/ DEXTROAMPHETAMINE SULFATE 1.25 MG ORAL TABLET [ADDERALL]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "541892",
  "drug_name" : "AMPHETAMINE ASPARTATE 2.5 MG \\/ AMPHETAMINE SULFATE 2.5 MG \\/ DEXTROAMPHETAMINE SACCHARATE 2.5 MG \\/ DEXTROAMPHETAMINE SULFATE 2.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "542370",
  "drug_name" : "NELFINAVIR 625 MG ORAL TABLET [VIRACEPT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "543460",
  "drug_name" : "AMMONIUM LACTATE 120 MG\\/ML TOPICAL CREAM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "543546",
  "drug_name" : "NYSTATIN 100000 UNT\\/ML TOPICAL CREAM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "544455",
  "drug_name" : "LACTULOSE 667 MG\\/ML ORAL SOLUTION [GENERLAC]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "544840",
  "drug_name" : "DOXYCYCLINE HYCLATE 100 MG INJECTION [DOXY]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "545236",
  "drug_name" : "GENTAMICIN 0.003 MG\\/MG OPHTHALMIC OINTMENT [GENTAK]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "545357",
  "drug_name" : "PALIFERMIN 6.25 MG INJECTION [KEPIVANCE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "545835",
  "drug_name" : "LEUPROLIDE ACETATE 5 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "562251",
  "drug_name" : "AMOXICILLIN 250 MG \\/ CLAVULANATE 125 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "562266",
  "drug_name" : "CLINDAMYCIN 15 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "562501",
  "drug_name" : "EPOPROSTENOL 0.5 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "562502",
  "drug_name" : "EPOPROSTENOL 1.5 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "562508",
  "drug_name" : "AMOXICILLIN 875 MG \\/ CLAVULANATE 125 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "562524",
  "drug_name" : "12 HR ACETAZOLAMIDE 500 MG EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "562704",
  "drug_name" : "ROPINIROLE 4 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "562806",
  "drug_name" : "PIMECROLIMUS 10 MG\\/ML TOPICAL CREAM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "562847",
  "drug_name" : "BETAINE 1000 MG POWDER FOR ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "577033",
  "drug_name" : "SILDENAFIL 20 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "577057",
  "drug_name" : "72 HR FENTANYL 0.012 MG\\/HR TRANSDERMAL SYSTEM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "577127",
  "drug_name" : "PREGABALIN 225 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "577208",
  "drug_name" : "OMEGA-3 ACID ETHYL ESTERS (USP) 1000 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "577776",
  "drug_name" : "CANDESARTAN CILEXETIL 16 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "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" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "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" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "577962",
  "drug_name" : "AMPHETAMINE ASPARTATE 5 MG \\/ AMPHETAMINE SULFATE 5 MG \\/ DEXTROAMPHETAMINE SACCHARATE 5 MG \\/ DEXTROAMPHETAMINE SULFATE 5 MG ORAL TABLET [ADDERALL]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "578018",
  "drug_name" : "BROMFENAC 0.9 MG\\/ML OPHTHALMIC SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "578803",
  "drug_name" : "BETAMETHASONE 3 MG\\/ML \\/ BETAMETHASONE ACETATE 3 MG\\/ML INJECTABLE SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "579148",
  "drug_name" : "GALANTAMINE 12 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "580286",
  "drug_name" : "MESALAMINE 500 MG EXTENDED RELEASE ORAL CAPSULE [PENTASA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "581531",
  "drug_name" : "TIGECYCLINE 50 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "582299",
  "drug_name" : "6-AMINOCAPROIC ACID 250 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "582926",
  "drug_name" : "PODOFILOX 5 MG\\/ML TOPICAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "583170",
  "drug_name" : "SALSALATE 750 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "583214",
  "drug_name" : "PACLITAXEL 100 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "583218",
  "drug_name" : "PACLITAXEL 100 MG INJECTION [ABRAXANE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "584222",
  "drug_name" : "5 ML GALSULFASE 1 MG\\/ML INJECTION [NAGLAZYME]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "596926",
  "drug_name" : "DULOXETINE 20 MG DELAYED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "596930",
  "drug_name" : "DULOXETINE 30 MG DELAYED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "596934",
  "drug_name" : "DULOXETINE 60 MG DELAYED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "597195",
  "drug_name" : "CARBOPLATIN 10 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "597730",
  "drug_name" : "LOPINAVIR 200 MG \\/ RITONAVIR 50 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "597747",
  "drug_name" : "SORAFENIB 200 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "597768",
  "drug_name" : "DEFERASIROX 125 MG TABLET FOR ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "597770",
  "drug_name" : "DEFERASIROX 250 MG TABLET FOR ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "597772",
  "drug_name" : "DEFERASIROX 500 MG TABLET FOR ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "597823",
  "drug_name" : "TOBRAMYCIN 40 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "597850",
  "drug_name" : "ANAGRELIDE 0.5 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "597852",
  "drug_name" : "ANAGRELIDE 1 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "598006",
  "drug_name" : "ERYTHROMYCIN 250 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "598025",
  "drug_name" : "AMOXICILLIN 250 MG CHEWABLE TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "602393",
  "drug_name" : "ABACAVIR 600 MG \\/ LAMIVUDINE 300 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "602399",
  "drug_name" : "GABAPENTIN 100 MG ORAL TABLET [GABARONE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "602407",
  "drug_name" : "GABAPENTIN 400 MG ORAL TABLET [GABARONE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "602635",
  "drug_name" : "LANTHANUM CARBONATE 1000 MG CHEWABLE TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "602910",
  "drug_name" : "LENALIDOMIDE 10 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "602912",
  "drug_name" : "LENALIDOMIDE 5 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "602964",
  "drug_name" : "ARIPIPRAZOLE 2 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "603203",
  "drug_name" : "ERLOTINIB 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "603206",
  "drug_name" : "ERLOTINIB 150 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "603208",
  "drug_name" : "ERLOTINIB 25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "603378",
  "drug_name" : "TIPRANAVIR 250 MG ORAL CAPSULE [APTIVUS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "603566",
  "drug_name" : "50 ML NELARABINE 5 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "607579",
  "drug_name" : "ENTECAVIR 0.05 MG\\/ML ORAL SOLUTION [BARACLUDE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "608139",
  "drug_name" : "ATOMOXETINE 100 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "608143",
  "drug_name" : "ATOMOXETINE 80 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "608328",
  "drug_name" : "RASAGILINE 1 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "608934",
  "drug_name" : "METRONIDAZOLE 0.0075 MG\\/MG VAGINAL GEL [VANDAZOLE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "615099",
  "drug_name" : "1000 ML GLUCOSE 50 MG\\/ML \\/ POTASSIUM CHLORIDE 0.03 MEQ\\/ML \\/ SODIUM CHLORIDE 4.5 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "615100",
  "drug_name" : "1000 ML GLUCOSE 50 MG\\/ML \\/ POTASSIUM CHLORIDE 0.04 MEQ\\/ML \\/ SODIUM CHLORIDE 4.5 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "615107",
  "drug_name" : "1000 ML GLUCOSE 50 MG\\/ML \\/ POTASSIUM CHLORIDE 0.02 MEQ\\/ML \\/ SODIUM CHLORIDE 9 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "615111",
  "drug_name" : "1000 ML GLUCOSE 50 MG\\/ML \\/ POTASSIUM CHLORIDE 0.04 MEQ\\/ML \\/ SODIUM CHLORIDE 9 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "615882",
  "drug_name" : "MECASERMIN 10 MG\\/ML INJECTABLE SOLUTION [INCRELEX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "616018",
  "drug_name" : "ABATACEPT 250 MG INJECTION [ORENCIA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "616148",
  "drug_name" : "EMTRICITABINE 10 MG\\/ML ORAL SOLUTION [EMTRIVA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "616279",
  "drug_name" : "SUNITINIB 12.5 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "616283",
  "drug_name" : "SUNITINIB 12.5 MG ORAL CAPSULE [SUTENT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "616285",
  "drug_name" : "SUNITINIB 25 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "616287",
  "drug_name" : "SUNITINIB 25 MG ORAL CAPSULE [SUTENT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "616289",
  "drug_name" : "SUNITINIB 50 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "616292",
  "drug_name" : "SUNITINIB 50 MG ORAL CAPSULE [SUTENT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "616402",
  "drug_name" : "DULOXETINE 40 MG DELAYED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "616483",
  "drug_name" : "QUETIAPINE 400 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "616487",
  "drug_name" : "QUETIAPINE 50 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "616578",
  "drug_name" : "LUBIPROSTONE 0.024 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "616698",
  "drug_name" : "RISPERIDONE 3 MG DISINTEGRATING ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "616705",
  "drug_name" : "RISPERIDONE 4 MG DISINTEGRATING ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "616749",
  "drug_name" : "12 HR RANOLAZINE 500 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "617296",
  "drug_name" : "AMOXICILLIN 500 MG \\/ CLAVULANATE 125 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "617309",
  "drug_name" : "AMOXICILLIN 200 MG \\/ CLAVULANATE 28.5 MG CHEWABLE TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "617310",
  "drug_name" : "ATORVASTATIN 20 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "617311",
  "drug_name" : "ATORVASTATIN 40 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "617312",
  "drug_name" : "ATORVASTATIN 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "617316",
  "drug_name" : "AMOXICILLIN 400 MG \\/ CLAVULANATE 57 MG CHEWABLE TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "617322",
  "drug_name" : "AMOXICILLIN 50 MG\\/ML \\/ CLAVULANATE 12.5 MG\\/ML ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "617333",
  "drug_name" : "AMOXICILLIN 25 MG\\/ML \\/ CLAVULANATE 6.25 MG\\/ML ORAL SUSPENSION [AUGMENTIN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "617423",
  "drug_name" : "AMOXICILLIN 40 MG\\/ML \\/ CLAVULANATE 5.7 MG\\/ML ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "617430",
  "drug_name" : "AMOXICILLIN 80 MG\\/ML \\/ CLAVULANATE 11.4 MG\\/ML ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "617993",
  "drug_name" : "AMOXICILLIN 120 MG\\/ML \\/ CLAVULANATE 8.58 MG\\/ML ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "618552",
  "drug_name" : "MECLOFENAMATE 100 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "618557",
  "drug_name" : "MECLOFENAMATE 50 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "628953",
  "drug_name" : "POTASSIUM CHLORIDE 10 MEQ EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "628958",
  "drug_name" : "POTASSIUM CHLORIDE 10 MEQ EXTENDED RELEASE ORAL TABLET [KLOR-CON]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "630208",
  "drug_name" : "ALBUTEROL 0.83 MG\\/ML INHALATION SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "630796",
  "drug_name" : "1000 ML GLUCOSE 50 MG\\/ML \\/ POTASSIUM CHLORIDE 0.01 MEQ\\/ML \\/ SODIUM CHLORIDE 4.5 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "636042",
  "drug_name" : "HYDROCHLOROTHIAZIDE 12.5 MG \\/ VALSARTAN 320 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "636045",
  "drug_name" : "HYDROCHLOROTHIAZIDE 25 MG \\/ VALSARTAN 320 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "636631",
  "drug_name" : "DECITABINE 50 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "636664",
  "drug_name" : "RASAGILINE 0.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "636671",
  "drug_name" : "VARENICLINE 0.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "636676",
  "drug_name" : "VARENICLINE 1 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "637216",
  "drug_name" : "NALTREXONE 380 MG INJECTION [VIVITROL]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "637549",
  "drug_name" : "TOPOTECAN 1 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "637551",
  "drug_name" : "1000 ML POTASSIUM CHLORIDE 0.02 MEQ\\/ML \\/ SODIUM CHLORIDE 9 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "639537",
  "drug_name" : "CANDESARTAN CILEXETIL 32 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "642452",
  "drug_name" : "LANTHANUM CARBONATE 750 MG CHEWABLE TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "643019",
  "drug_name" : "ARIPIPRAZOLE 10 MG DISINTEGRATING ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "643022",
  "drug_name" : "ARIPIPRAZOLE 15 MG DISINTEGRATING ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "643066",
  "drug_name" : "EFAVIRENZ 600 MG \\/ EMTRICITABINE 200 MG \\/ TENOFOVIR DISOPROXIL FUMARATE 300 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "643105",
  "drug_name" : "DASATINIB 20 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "643107",
  "drug_name" : "DASATINIB 50 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "643109",
  "drug_name" : "DASATINIB 70 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "643488",
  "drug_name" : "ISOTRETINOIN 30 MG ORAL CAPSULE [CLARAVIS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "643712",
  "drug_name" : "LENALIDOMIDE 15 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "643720",
  "drug_name" : "LENALIDOMIDE 25 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "644088",
  "drug_name" : "APREPITANT 40 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "644304",
  "drug_name" : "TAMOXIFEN 2 MG\\/ML ORAL SOLUTION [SOLTAMOX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "645037",
  "drug_name" : "RISPERIDONE 0.25 MG DISINTEGRATING ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "645884",
  "drug_name" : "SOMATROPIN 5 MG\\/ML INJECTABLE SOLUTION [OMNITROPE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "646456",
  "drug_name" : "NYSTATIN 100 UNT\\/MG TOPICAL POWDER",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "647118",
  "drug_name" : "3 ML IDURSULFASE 2 MG\\/ML INJECTION [ELAPRASE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "647121",
  "drug_name" : "5 ML LEVETIRACETAM 100 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "656659",
  "drug_name" : "BOSENTAN 125 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "664741",
  "drug_name" : "ATAZANAVIR 300 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "665019",
  "drug_name" : "POSACONAZOLE 40 MG\\/ML ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "665033",
  "drug_name" : "SITAGLIPTIN 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "665038",
  "drug_name" : "SITAGLIPTIN 25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "665042",
  "drug_name" : "SITAGLIPTIN 50 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "667904",
  "drug_name" : "SALICYLIC ACID 60 MG\\/ML MEDICATED SHAMPOO",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "668363",
  "drug_name" : "FENTANYL 0.1 MG BUCCAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "668364",
  "drug_name" : "FENTANYL 0.2 MG BUCCAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "668365",
  "drug_name" : "FENTANYL 0.4 MG BUCCAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "668366",
  "drug_name" : "FENTANYL 0.6 MG BUCCAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "668367",
  "drug_name" : "FENTANYL 0.8 MG BUCCAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "668606",
  "drug_name" : "VORINOSTAT 100 MG ORAL CAPSULE [ZOLINZA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "668956",
  "drug_name" : "ARFORMOTEROL 0.0075 MG\\/ML INHALATION SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "670026",
  "drug_name" : "DARUNAVIR 600 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "672149",
  "drug_name" : "LAPATINIB 250 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "672567",
  "drug_name" : "24 HR PALIPERIDONE 3 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "672569",
  "drug_name" : "24 HR PALIPERIDONE 6 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "672571",
  "drug_name" : "24 HR PALIPERIDONE 9 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "686161",
  "drug_name" : "CARBOPLATIN 10 MG\\/ML INJECTABLE SOLUTION [PARAPLATIN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "686379",
  "drug_name" : "CELECOXIB 50 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "686429",
  "drug_name" : "MESALAMINE 1200 MG DELAYED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "686924",
  "drug_name" : "CARVEDILOL 3.125 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "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" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "700418",
  "drug_name" : "THALIDOMIDE 150 MG ORAL CAPSULE [THALOMID]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "701305",
  "drug_name" : "TRETINOIN 0.00025 MG\\/MG TOPICAL GEL [RETIN-A]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "702519",
  "drug_name" : "PHENOBARBITAL 4 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "705129",
  "drug_name" : "NITROGLYCERIN 0.4 MG\\/ACTUAT MUCOSAL SPRAY",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "705824",
  "drug_name" : "100 ML ZOLEDRONIC ACID 0.05 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "706548",
  "drug_name" : "SELENIUM SULFIDE 22.5 MG\\/ML MEDICATED SHAMPOO",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "706822",
  "drug_name" : "RISPERIDONE 12.5 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "706825",
  "drug_name" : "RISPERIDONE 12.5 MG INJECTION [RISPERDAL]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "706827",
  "drug_name" : "RISPERIDONE 37.5 MG INJECTION [RISPERDAL]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "706829",
  "drug_name" : "RISPERIDONE 50 MG INJECTION [RISPERDAL]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "706831",
  "drug_name" : "RISPERIDONE 25 MG INJECTION [RISPERDAL]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "721773",
  "drug_name" : "CLOZAPINE 12.5 MG DISINTEGRATING ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "721787",
  "drug_name" : "FLUOXETINE 25 MG \\/ OLANZAPINE 3 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "721791",
  "drug_name" : "24 HR QUETIAPINE 200 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "721794",
  "drug_name" : "24 HR QUETIAPINE 300 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "721796",
  "drug_name" : "24 HR QUETIAPINE 400 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "722111",
  "drug_name" : "ADAPALENE 0.003 MG\\/MG TOPICAL GEL",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "722116",
  "drug_name" : "AMBRISENTAN 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "722122",
  "drug_name" : "AMBRISENTAN 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "722289",
  "drug_name" : "1.2 ML TEMSIROLIMUS 25 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "723827",
  "drug_name" : "FOSAMPRENAVIR 50 MG\\/ML ORAL SUSPENSION [LEXIVA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "724859",
  "drug_name" : "ARMODAFINIL 150 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "724861",
  "drug_name" : "ARMODAFINIL 250 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "724863",
  "drug_name" : "ARMODAFINIL 50 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "725098",
  "drug_name" : "PROGESTERONE 100 MG VAGINAL INSERT [ENDOMETRIN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "727316",
  "drug_name" : "NDA019430 0.3 ML EPINEPHRINE 0.5 MG\\/ML AUTO-INJECTOR",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "727355",
  "drug_name" : "4 ML ADENOSINE 3 MG\\/ML PREFILLED SYRINGE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "727373",
  "drug_name" : "10 ML EPINEPHRINE 0.1 MG\\/ML PREFILLED SYRINGE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "727517",
  "drug_name" : "50 ML GLUCOSE 500 MG\\/ML PREFILLED SYRINGE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "727705",
  "drug_name" : "0.8 ML ADALIMUMAB 50 MG\\/ML PREFILLED SYRINGE [HUMIRA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "727714",
  "drug_name" : "0.67 ML ANAKINRA 149 MG\\/ML PREFILLED SYRINGE [KINERET]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "727762",
  "drug_name" : "5 ML FULVESTRANT 50 MG\\/ML PREFILLED SYRINGE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "727816",
  "drug_name" : "0.5 ML INTERFERON BETA-1A 0.06 MG\\/ML PREFILLED SYRINGE [AVONEX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "728109",
  "drug_name" : "OSELTAMIVIR 30 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "728113",
  "drug_name" : "OSELTAMIVIR 45 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "728223",
  "drug_name" : "MARAVIROC 150 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "728225",
  "drug_name" : "MARAVIROC 300 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "728231",
  "drug_name" : "12 HR RANOLAZINE 1000 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "729234",
  "drug_name" : "SOMATROPIN 6 MG CARTRIDGE [HUMATROPE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "730046",
  "drug_name" : "0.5 ML DARBEPOETIN ALFA 0.2 MG\\/ML PREFILLED SYRINGE [ARANESP]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "730781",
  "drug_name" : "500 ML SODIUM CHLORIDE 30 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "730782",
  "drug_name" : "500 ML SODIUM CHLORIDE 50 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "730834",
  "drug_name" : "12 HR ZILEUTON 600 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "730988",
  "drug_name" : "CARBIDOPA 50 MG \\/ ENTACAPONE 200 MG \\/ LEVODOPA 200 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "731229",
  "drug_name" : "0.6 ML DARBEPOETIN ALFA 0.5 MG\\/ML PREFILLED SYRINGE [ARANESP]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "731231",
  "drug_name" : "0.3 ML DARBEPOETIN ALFA 0.5 MG\\/ML PREFILLED SYRINGE [ARANESP]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "731235",
  "drug_name" : "0.4 ML DARBEPOETIN ALFA 0.5 MG\\/ML PREFILLED SYRINGE [ARANESP]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "731241",
  "drug_name" : "1 ML DARBEPOETIN ALFA 0.5 MG\\/ML PREFILLED SYRINGE [ARANESP]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "731250",
  "drug_name" : "0.3 ML DARBEPOETIN ALFA 0.2 MG\\/ML PREFILLED SYRINGE [ARANESP]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "731328",
  "drug_name" : "0.5 ML PEGINTERFERON ALFA-2A 0.36 MG\\/ML PREFILLED SYRINGE [PEGASYS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "731541",
  "drug_name" : "2 ML PENICILLIN G BENZATHINE 300000 UNT\\/ML \\/ PENICILLIN G PROCAINE 300000 UNT\\/ML PREFILLED SYRINGE [BICILLIN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "731566",
  "drug_name" : "1 ML PENICILLIN G BENZATHINE 600000 UNT\\/ML PREFILLED SYRINGE [BICILLIN L-A]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "731568",
  "drug_name" : "2 ML PENICILLIN G BENZATHINE 600000 UNT\\/ML PREFILLED SYRINGE [BICILLIN L-A]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "731571",
  "drug_name" : "4 ML PENICILLIN G BENZATHINE 600000 UNT\\/ML PREFILLED SYRINGE [BICILLIN L-A]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "744846",
  "drug_name" : "RALTEGRAVIR 400 MG ORAL TABLET [ISENTRESS]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "745302",
  "drug_name" : "PENICILLIN G SODIUM 100000 UNT\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "745462",
  "drug_name" : "2 ML PENICILLIN G PROCAINE 600000 UNT\\/ML PREFILLED SYRINGE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "746606",
  "drug_name" : "NILOTINIB 200 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "746645",
  "drug_name" : "LOPINAVIR 100 MG \\/ RITONAVIR 25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "748798",
  "drug_name" : "{24 (DROSPIRENONE 3 MG \\/ ETHINYL ESTRADIOL 0.02 MG ORAL TABLET) \\/ 4 (INERT INGREDIENTS 1 MG ORAL TABLET) } PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "748800",
  "drug_name" : "{21 (DROSPIRENONE 3 MG \\/ ETHINYL ESTRADIOL 0.03 MG ORAL TABLET) \\/ 7 (INERT INGREDIENTS 1 MG ORAL TABLET) } PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "748806",
  "drug_name" : "{21 (ETHINYL ESTRADIOL 0.05 MG \\/ ETHYNODIOL DIACETATE 1 MG ORAL TABLET) \\/ 7 (INERT INGREDIENTS 1 MG ORAL TABLET) } PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "748865",
  "drug_name" : "TRIVORA 28 DAY PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "748879",
  "drug_name" : "LEVORA 0.15\\/30 28 DAY PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "748961",
  "drug_name" : "{28 (NORETHINDRONE 0.35 MG ORAL TABLET) } PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "748977",
  "drug_name" : "NORA-BE 28 DAY PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "749148",
  "drug_name" : "LEENA 28 DAY PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "749206",
  "drug_name" : "SEVELAMER CARBONATE 800 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "749289",
  "drug_name" : "{11 (VARENICLINE 0.5 MG ORAL TABLET) \\/ 42 (VARENICLINE 1 MG ORAL TABLET) } PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "749783",
  "drug_name" : "{6 (AZITHROMYCIN 250 MG ORAL TABLET) } PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "749788",
  "drug_name" : "{56 (VARENICLINE 1 MG ORAL TABLET) } PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "749813",
  "drug_name" : "0.2 ML LANREOTIDE 300 MG\\/ML PREFILLED SYRINGE [SOMATULINE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "749814",
  "drug_name" : "0.5 ML LANREOTIDE 240 MG\\/ML PREFILLED SYRINGE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "749816",
  "drug_name" : "0.5 ML LANREOTIDE 240 MG\\/ML PREFILLED SYRINGE [SOMATULINE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "749818",
  "drug_name" : "0.3 ML LANREOTIDE 300 MG\\/ML PREFILLED SYRINGE [SOMATULINE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "750265",
  "drug_name" : "CRYSELLE 28 DAY PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "750267",
  "drug_name" : "ARANELLE 28 DAY PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "750268",
  "drug_name" : "AVIANE 28 DAY PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "751139",
  "drug_name" : "{35 (LAMOTRIGINE 25 MG ORAL TABLET) } PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "751563",
  "drug_name" : "{7 (LAMOTRIGINE 100 MG ORAL TABLET) \\/ 42 (LAMOTRIGINE 25 MG ORAL TABLET) } PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "751612",
  "drug_name" : "NEBIVOLOL 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "751618",
  "drug_name" : "NEBIVOLOL 2.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "751868",
  "drug_name" : "NORTREL 0.5\\/35 28 DAY PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "751870",
  "drug_name" : "NORTREL 1\\/35 28 DAY PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "751871",
  "drug_name" : "NORTREL 1\\/35 21 DAY PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "751875",
  "drug_name" : "NECON 0.5\\/35 28 DAY PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "751884",
  "drug_name" : "LUTERA 28 DAY PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "751890",
  "drug_name" : "PORTIA 28 DAY PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "751970",
  "drug_name" : "0.5 ML INTERFERON GAMMA-1B 0.2 MG\\/ML INJECTION [ACTIMMUNE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "753451",
  "drug_name" : "{14 (LAMOTRIGINE 100 MG ORAL TABLET) \\/ 84 (LAMOTRIGINE 25 MG ORAL TABLET) } PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "753481",
  "drug_name" : "SPRINTEC 28 DAY PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "753482",
  "drug_name" : "APRI 28 DAY PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "753483",
  "drug_name" : "KELNOR 1\\/35 28 DAY PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "753543",
  "drug_name" : "RECLIPSEN 28 DAY PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "754508",
  "drug_name" : "{1 (APREPITANT 125 MG ORAL CAPSULE) \\/ 2 (APREPITANT 80 MG ORAL CAPSULE) } PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "754512",
  "drug_name" : "HYDROXYPROPYLCELLULOSE 5 MG DRUG IMPLANT [LACRISERT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "754761",
  "drug_name" : "ETRAVIRINE 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "755470",
  "drug_name" : "LACTULOSE 667 MG\\/ML ORAL SOLUTION [ENULOSE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "755497",
  "drug_name" : "ALBUTEROL 0.4 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "756059",
  "drug_name" : "LITHIUM CITRATE 60 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "756209",
  "drug_name" : "ZIDOVUDINE 10 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "756226",
  "drug_name" : "THEOPHYLLINE 5.33 MG\\/ML ORAL SOLUTION [ELIXOPHYLLIN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "756245",
  "drug_name" : "ACETAMINOPHEN 21.7 MG\\/ML \\/ BUTALBITAL 3.33 MG\\/ML \\/ CAFFEINE 2.67 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "757707",
  "drug_name" : "TADALAFIL 2.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "759473",
  "drug_name" : "20 ACTUAT ZANAMIVIR 5 MG\\/ACTUAT DRY POWDER INHALER [RELENZA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "762007",
  "drug_name" : "NORTREL 7\\/7\\/7 28 DAY PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "762333",
  "drug_name" : "TRI-SPRINTEC 28 DAY PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "762602",
  "drug_name" : "SALMONELLA TYPHI TY21A LIVE ANTIGEN 2000000000 UNT DELAYED RELEASE ORAL CAPSULE [VIVOTIF]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "762675",
  "drug_name" : "{21 (METHYLPREDNISOLONE 4 MG ORAL TABLET) } PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "763106",
  "drug_name" : "POLIOVIRUS VACCINE INACTIVATED, TYPE 1 (MAHONEY) 80 UNT\\/ML \\/ POLIOVIRUS VACCINE INACTIVATED, TYPE 2 (MEF-1) 16 UNT\\/ML \\/ POLIOVIRUS VACCINE INACTIVATED, TYPE 3 (SAUKETT) 64 UNT\\/ML INJECTABLE SUSPENSION [IPOL]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "763179",
  "drug_name" : "{48 (PREDNISONE 5 MG ORAL TABLET) } PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "763181",
  "drug_name" : "{21 (PREDNISONE 5 MG ORAL TABLET) } PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "763183",
  "drug_name" : "{48 (PREDNISONE 10 MG ORAL TABLET) } PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "763185",
  "drug_name" : "{21 (PREDNISONE 10 MG ORAL TABLET) } PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "763457",
  "drug_name" : "RILONACEPT 220 MG INJECTION [ARCALYST]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "789980",
  "drug_name" : "AMPICILLIN 100 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "792577",
  "drug_name" : "10 ML SODIUM BICARBONATE 84 MG\\/ML PREFILLED SYRINGE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "794639",
  "drug_name" : "LUBIPROSTONE 0.008 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "795085",
  "drug_name" : "CERTOLIZUMAB PEGOL 200 MG INJECTION [CIMZIA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "795749",
  "drug_name" : "REBIF TITRATION PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "797274",
  "drug_name" : "CLINDAMYCIN 10 MG\\/ML MEDICATED PAD",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "797544",
  "drug_name" : "ISOPROPYL ALCOHOL 0.7 ML\\/ML MEDICATED PAD",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "797641",
  "drug_name" : "[MENACTRA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "797697",
  "drug_name" : "FLURANDRENOLIDE 0.004 MG\\/SQCM MEDICATED TAPE [CORDRAN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "798300",
  "drug_name" : "[8] VACCINE 1150000 UNT\\/ML ORAL SUSPENSION [ROTATE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "798428",
  "drug_name" : "1 ML HEPATITIS B SURFACE ANTIGEN VACCINE 0.02 MG\\/ML PREFILLED SYRINGE [ENGERIX-B]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "798430",
  "drug_name" : "0.5 ML HEPATITIS B SURFACE ANTIGEN VACCINE 0.02 MG\\/ML PREFILLED SYRINGE [ENGERIX-B]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "798451",
  "drug_name" : "0.5 ML HAEMOPHILUS INFLUENZAE B (ROSS STRAIN) CAPSULAR POLYSACCHARIDE MENINGOCOCCAL PROTEIN CONJUGATE VACCINE 0.265 MG\\/ML INJECTION [PEDVAXHIB]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "798479",
  "drug_name" : "1 ML HEPATITIS A VACCINE (INACTIVATED) STRAIN HM175 1440 UNT\\/ML PREFILLED SYRINGE [HAVRIX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "798482",
  "drug_name" : "0.5 ML HEPATITIS A VACCINE (INACTIVATED) STRAIN HM175 1440 UNT\\/ML PREFILLED SYRINGE [HAVRIX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "799037",
  "drug_name" : "60 ACTUAT CICLESONIDE 0.16 MG\\/ACTUAT METERED DOSE INHALER [ALVESCO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "799040",
  "drug_name" : "60 ACTUAT CICLESONIDE 0.08 MG\\/ACTUAT METERED DOSE INHALER [ALVESCO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "799047",
  "drug_name" : "DASATINIB 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "799054",
  "drug_name" : "24 HR ROPINIROLE 8 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "799055",
  "drug_name" : "24 HR ROPINIROLE 2 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "799056",
  "drug_name" : "24 HR ROPINIROLE 4 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "800405",
  "drug_name" : "[CLINIMIX 4.25\\/10]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "800420",
  "drug_name" : "[CLINIMIX 4.25\\/5]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "800438",
  "drug_name" : "[CLINIMIX 5\\/15]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "800444",
  "drug_name" : "[CLINIMIX 5\\/20]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "800588",
  "drug_name" : "[CLINISOL 15]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "801000",
  "drug_name" : "[CLINIMIX E 4.25\\/5]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "801012",
  "drug_name" : "[CLINIMIX E 2.75\\/5]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "801021",
  "drug_name" : "[CLINIMIX E 5\\/15]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "801031",
  "drug_name" : "[CLINIMIX E 5\\/20]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "801054",
  "drug_name" : "POLYETHYLENE GLYCOL 3350 420000 MG \\/ POTASSIUM CHLORIDE 1480 MG \\/ SODIUM BICARBONATE 5720 MG \\/ SODIUM CHLORIDE 11200 MG POWDER FOR ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "801112",
  "drug_name" : "MAGNESIUM CHLORIDE 0.00148 MEQ\\/ML \\/ POTASSIUM CHLORIDE 0.00497 MEQ\\/ML \\/ SODIUM ACETATE 0.027 MEQ\\/ML \\/ SODIUM CHLORIDE 0.0899 MEQ\\/ML \\/ SODIUM GLUCONATE 5.02 MG\\/ML INJECTABLE SOLUTION [PLASMALYTE A]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "801185",
  "drug_name" : "OCELLA 28 DAY PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "801357",
  "drug_name" : "MAGNESIUM CHLORIDE 0.00148 MEQ\\/ML \\/ POTASSIUM CHLORIDE 0.00497 MEQ\\/ML \\/ SODIUM ACETATE 0.027 MEQ\\/ML \\/ SODIUM CHLORIDE 0.0899 MEQ\\/ML \\/ SODIUM GLUCONATE 5.02 MG\\/ML INJECTABLE SOLUTION [PLASMA-LYTE 148]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "801405",
  "drug_name" : "[PREMASOL]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "801445",
  "drug_name" : "MAGNESIUM SULFATE 0.2 MG\\/ML \\/ MONOBASIC POTASSIUM PHOSPHATE 0.063 MG\\/ML \\/ POTASSIUM CHLORIDE 0.005 MEQ\\/ML \\/ SODIUM CHLORIDE 0.14 MEQ\\/ML \\/ SODIUM PHOSPHATE DIHYDRATE 0.088 MG\\/ML IRRIGATION SOLUTION [TIS-U-SOL]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "801648",
  "drug_name" : "[TRAVASOL 10]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "801925",
  "drug_name" : "MAGNESIUM CHLORIDE 0.3 MG\\/ML \\/ POTASSIUM CHLORIDE 0.37 MG\\/ML \\/ SODIUM ACETATE 2.22 MG\\/ML \\/ SODIUM CHLORIDE 5.26 MG\\/ML \\/ SODIUM GLUCONATE 5.02 MG\\/ML IRRIGATION SOLUTION [PHYSIOSOL]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "801957",
  "drug_name" : "0.5 ML DIAZEPAM 5 MG\\/ML RECTAL GEL",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "801961",
  "drug_name" : "2 ML DIAZEPAM 5 MG\\/ML RECTAL GEL",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "801962",
  "drug_name" : "2 ML DIAZEPAM 5 MG\\/ML RECTAL GEL [DIASTAT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "801965",
  "drug_name" : "4 ML DIAZEPAM 5 MG\\/ML RECTAL GEL [DIASTAT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "801966",
  "drug_name" : "4 ML DIAZEPAM 5 MG\\/ML RECTAL GEL",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "802652",
  "drug_name" : "1 ML ETANERCEPT 50 MG\\/ML PREFILLED SYRINGE [ENBREL]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "803371",
  "drug_name" : "1 ML HEPATITIS A VACCINE (INACTIVATED) STRAIN HM175 720 UNT\\/ML \\/ HEPATITIS B SURFACE ANTIGEN VACCINE 0.02 MG\\/ML PREFILLED SYRINGE [TWINRIX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "804186",
  "drug_name" : "0.5 ML MEASLES VIRUS VACCINE LIVE, ENDERS' ATTENUATED EDMONSTON STRAIN 2000 UNT\\/ML \\/ MUMPS VIRUS VACCINE LIVE, JERYL LYNN STRAIN 25000 UNT\\/ML \\/ RUBELLA VIRUS VACCINE LIVE (WISTAR RA 27-3 STRAIN) 2000 UNT\\/ML INJECTION [M-M-R II]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "804544",
  "drug_name" : "DIFLUPREDNATE 0.5 MG\\/ML OPHTHALMIC SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "805464",
  "drug_name" : "TETRABENAZINE 12.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "805579",
  "drug_name" : "ROTAVIRUS VACCINE, LIVE ATTENUATED, G1P[8] HUMAN 89-12 STRAIN 1000000 UNT\\/ML ORAL SUSPENSION [ROTARIX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "807225",
  "drug_name" : "TYPHOID VI POLYSACCHARIDE VACCINE, S TYPHI TY2 STRAIN 0.05 MG\\/ML INJECTABLE SOLUTION [TYPHIM VI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "807283",
  "drug_name" : "LEVONORGESTREL 0.000833 MG\\/HR INTRAUTERINE SYSTEM [MIRENA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "807832",
  "drug_name" : "24 HR LEVETIRACETAM 500 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "808118",
  "drug_name" : "PREDNISOLONE 5 MG ORAL TABLET [MILLIPRED]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "808744",
  "drug_name" : "24 HR VENLAFAXINE 150 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "808748",
  "drug_name" : "24 HR VENLAFAXINE 225 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "808751",
  "drug_name" : "24 HR VENLAFAXINE 37.5 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "808753",
  "drug_name" : "24 HR VENLAFAXINE 75 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "808917",
  "drug_name" : "FOSFOMYCIN 3000 MG GRANULES FOR ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "809159",
  "drug_name" : "0.5 ML ETANERCEPT 50 MG\\/ML PREFILLED SYRINGE [ENBREL]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "809477",
  "drug_name" : "SILODOSIN 8 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "809871",
  "drug_name" : "C1 ESTERASE INHIBITOR (HUMAN) 500 UNT INJECTION [CINRYZE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "809974",
  "drug_name" : "20 ML LACOSAMIDE 10 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "809987",
  "drug_name" : "LACOSAMIDE 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "809992",
  "drug_name" : "LACOSAMIDE 150 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "809996",
  "drug_name" : "LACOSAMIDE 200 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "810000",
  "drug_name" : "LACOSAMIDE 50 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "810083",
  "drug_name" : "CARBIDOPA 31.25 MG \\/ ENTACAPONE 200 MG \\/ LEVODOPA 125 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "810090",
  "drug_name" : "CARBIDOPA 18.75 MG \\/ ENTACAPONE 200 MG \\/ LEVODOPA 75 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "824295",
  "drug_name" : "RUFINAMIDE 200 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "824301",
  "drug_name" : "RUFINAMIDE 400 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "824959",
  "drug_name" : "24 HR ROPINIROLE 12 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "825170",
  "drug_name" : "HUMIRA PEN 40 MG\\/0.8 ML - CROHN'S DISEASE STARTER PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "825325",
  "drug_name" : "0.375 ML LEUPROLIDE ACETATE 120 MG\\/ML PREFILLED SYRINGE [ELIGARD]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "825333",
  "drug_name" : "0.5 ML LEUPROLIDE ACETATE 60 MG\\/ML PREFILLED SYRINGE [ELIGARD]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "825334",
  "drug_name" : "0.25 ML LEUPROLIDE ACETATE 30 MG\\/ML PREFILLED SYRINGE [ELIGARD]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "825335",
  "drug_name" : "0.375 ML LEUPROLIDE ACETATE 60 MG\\/ML PREFILLED SYRINGE [ELIGARD]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "825421",
  "drug_name" : "ELTROMBOPAG 25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "825427",
  "drug_name" : "ELTROMBOPAG 50 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "826612",
  "drug_name" : "SILODOSIN 4 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "827073",
  "drug_name" : "NEBIVOLOL 20 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "827353",
  "drug_name" : "MAGNESIUM CHLORIDE 0.00148 MEQ\\/ML \\/ POTASSIUM CHLORIDE 0.005 MEQ\\/ML \\/ SODIUM ACETATE 0.027 MEQ\\/ML \\/ SODIUM CHLORIDE 0.09 MEQ\\/ML \\/ SODIUM GLUCONATE 0.023 MEQ\\/ML IRRIGATION SOLUTION [PHYSIOLYTE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "828248",
  "drug_name" : "CORTISONE ACETATE 25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "828320",
  "drug_name" : "CYCLOBENZAPRINE HYDROCHLORIDE 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "828348",
  "drug_name" : "CYCLOBENZAPRINE HYDROCHLORIDE 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "828364",
  "drug_name" : "HYDROCORTISONE ACETATE 10 MG\\/ML \\/ PRAMOXINE HYDROCHLORIDE 10 MG\\/ML RECTAL FOAM [PROCTOFOAM-HC]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "828539",
  "drug_name" : "CASPOFUNGIN ACETATE 70 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "828700",
  "drug_name" : "1.2 ML PLERIXAFOR 20 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "828703",
  "drug_name" : "1.2 ML PLERIXAFOR 20 MG\\/ML INJECTION [MOZOBIL]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "829500",
  "drug_name" : "MEFENAMIC ACID 250 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "829539",
  "drug_name" : "ADAPALENE 0.001 MG\\/MG \\/ BENZOYL PEROXIDE 0.025 MG\\/MG TOPICAL GEL",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "829734",
  "drug_name" : "50 ML MAGNESIUM SULFATE 80 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "829757",
  "drug_name" : "100 ML MAGNESIUM SULFATE 10 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "829762",
  "drug_name" : "10 ML MAGNESIUM SULFATE 500 MG\\/ML PREFILLED SYRINGE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "829989",
  "drug_name" : "[PEDIARIX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "830245",
  "drug_name" : "1 ML HEPATITIS B SURFACE ANTIGEN VACCINE 0.01 MG\\/ML PREFILLED SYRINGE [RECOMBIVAX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "830253",
  "drug_name" : "0.5 ML HEPATITIS B SURFACE ANTIGEN VACCINE 0.01 MG\\/ML PREFILLED SYRINGE [RECOMBIVAX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "830263",
  "drug_name" : "1 ML HEPATITIS B SURFACE ANTIGEN VACCINE 0.04 MG\\/ML INJECTION [RECOMBIVAX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "830463",
  "drug_name" : "1 ML RABIES VIRUS VACCINE FLURY-LEP STRAIN 2.5 UNT\\/ML INJECTION [RABAVERT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "830470",
  "drug_name" : "1 ML RABIES VIRUS VACCINE WISTAR STRAIN PM-1503-3M (HUMAN), INACTIVATED 2.5 UNT\\/ML INJECTION [IMOVAX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "830557",
  "drug_name" : "[KINRIX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "830795",
  "drug_name" : "24 HR DILTIAZEM HYDROCHLORIDE 360 MG EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "830801",
  "drug_name" : "24 HR DILTIAZEM HYDROCHLORIDE 300 MG EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "830837",
  "drug_name" : "24 HR DILTIAZEM HYDROCHLORIDE 240 MG EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "830845",
  "drug_name" : "24 HR DILTIAZEM HYDROCHLORIDE 180 MG EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "830861",
  "drug_name" : "24 HR DILTIAZEM HYDROCHLORIDE 120 MG EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "830865",
  "drug_name" : "12 HR DILTIAZEM HYDROCHLORIDE 60 MG EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "830869",
  "drug_name" : "12 HR DILTIAZEM HYDROCHLORIDE 90 MG EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "830872",
  "drug_name" : "12 HR DILTIAZEM HYDROCHLORIDE 120 MG EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "831054",
  "drug_name" : "DILTIAZEM HYDROCHLORIDE 120 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "831102",
  "drug_name" : "DILTIAZEM HYDROCHLORIDE 90 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "831103",
  "drug_name" : "DILTIAZEM HYDROCHLORIDE 60 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "831109",
  "drug_name" : "CROMOLYN SODIUM 40 MG\\/ML OPHTHALMIC SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "831215",
  "drug_name" : "24 HR DILTIAZEM HYDROCHLORIDE 120 MG EXTENDED RELEASE ORAL CAPSULE [DILT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "831226",
  "drug_name" : "24 HR DILTIAZEM HYDROCHLORIDE 120 MG EXTENDED RELEASE ORAL CAPSULE [CARTIA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "831246",
  "drug_name" : "CROMOLYN SODIUM 10 MG\\/ML INHALATION SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "831252",
  "drug_name" : "24 HR DILTIAZEM HYDROCHLORIDE 180 MG EXTENDED RELEASE ORAL CAPSULE [DILT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "831255",
  "drug_name" : "24 HR DILTIAZEM HYDROCHLORIDE 180 MG EXTENDED RELEASE ORAL CAPSULE [CARTIA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "831261",
  "drug_name" : "CROMOLYN SODIUM 20 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "831285",
  "drug_name" : "24 HR DILTIAZEM HYDROCHLORIDE 240 MG EXTENDED RELEASE ORAL CAPSULE [DILT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "831309",
  "drug_name" : "24 HR DILTIAZEM HYDROCHLORIDE 240 MG EXTENDED RELEASE ORAL CAPSULE [CARTIA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "831338",
  "drug_name" : "24 HR DILTIAZEM HYDROCHLORIDE 300 MG EXTENDED RELEASE ORAL CAPSULE [CARTIA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "831870",
  "drug_name" : "DARUNAVIR 75 MG ORAL TABLET [PREZISTA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "832718",
  "drug_name" : "POTASSIUM CHLORIDE 8 MEQ EXTENDED RELEASE ORAL TABLET [KLOR-CON]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "833008",
  "drug_name" : "DESMOPRESSIN ACETATE 0.2 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "833217",
  "drug_name" : "DILTIAZEM HYDROCHLORIDE 30 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "833461",
  "drug_name" : "BETAMETHASONE 0.5 MG\\/ML \\/ CALCIPOTRIENE 0.05 MG\\/ML TOPICAL LOTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "833528",
  "drug_name" : "AMIODARONE HYDROCHLORIDE 200 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "834040",
  "drug_name" : "PENICILLIN V POTASSIUM 50 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "834046",
  "drug_name" : "PENICILLIN V POTASSIUM 25 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "834061",
  "drug_name" : "PENICILLIN V POTASSIUM 250 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "834102",
  "drug_name" : "PENICILLIN V POTASSIUM 500 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "834127",
  "drug_name" : "CHLORHEXIDINE GLUCONATE 1.2 MG\\/ML MOUTHWASH",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "834235",
  "drug_name" : "FEBUXOSTAT 40 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "834241",
  "drug_name" : "FEBUXOSTAT 80 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "834348",
  "drug_name" : "AMIODARONE HYDROCHLORIDE 400 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "835572",
  "drug_name" : "IMIPRAMINE PAMOATE 75 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "835577",
  "drug_name" : "IMIPRAMINE PAMOATE 150 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "835589",
  "drug_name" : "IMIPRAMINE PAMOATE 125 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "835591",
  "drug_name" : "IMIPRAMINE PAMOATE 100 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "835593",
  "drug_name" : "IMIPRAMINE HYDROCHLORIDE 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "835603",
  "drug_name" : "TRAMADOL HYDROCHLORIDE 50 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "835721",
  "drug_name" : "ETHIONAMIDE 250 MG ORAL TABLET [TRECATOR]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "835726",
  "drug_name" : "ACAMPROSATE CALCIUM 333 MG DELAYED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "835809",
  "drug_name" : "TESTOSTERONE ENANTHATE 200 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "835829",
  "drug_name" : "TESTOSTERONE CYPIONATE 100 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "835831",
  "drug_name" : "TESTOSTERONE CYPIONATE 100 MG\\/ML INJECTABLE SOLUTION [DEPO-TESTOSTERONE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "835835",
  "drug_name" : "CYCLOSPORINE, MODIFIED 100 MG ORAL CAPSULE [GENGRAF]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "835840",
  "drug_name" : "TESTOSTERONE CYPIONATE 200 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "835842",
  "drug_name" : "TESTOSTERONE CYPIONATE 200 MG\\/ML INJECTABLE SOLUTION [DEPO-TESTOSTERONE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "835886",
  "drug_name" : "CYCLOSPORINE, MODIFIED 100 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "835894",
  "drug_name" : "CYCLOSPORINE, MODIFIED 25 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "835896",
  "drug_name" : "CYCLOSPORINE, MODIFIED 25 MG ORAL CAPSULE [GENGRAF]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "835913",
  "drug_name" : "MEFLOQUINE HYDROCHLORIDE 250 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "835925",
  "drug_name" : "CYCLOSPORINE, MODIFIED 50 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "835956",
  "drug_name" : "AMIODARONE HYDROCHLORIDE 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "836307",
  "drug_name" : "2 ML PENICILLIN G BENZATHINE 450000 UNT\\/ML \\/ PENICILLIN G PROCAINE 150000 UNT\\/ML PREFILLED SYRINGE [BICILLIN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "836358",
  "drug_name" : "IPRATROPIUM BROMIDE 0.2 MG\\/ML INHALATION SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "836368",
  "drug_name" : "200 ACTUAT IPRATROPIUM BROMIDE 0.017 MG\\/ACTUAT METERED DOSE INHALER [ATROVENT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "836395",
  "drug_name" : "ACETAMINOPHEN 325 MG \\/ TRAMADOL HYDROCHLORIDE 37.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "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" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "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" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "844591",
  "drug_name" : "THEOPHYLLINE 300 MG EXTENDED RELEASE ORAL CAPSULE [THEO-24]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "845488",
  "drug_name" : "RAMIPRIL 1.25 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "845507",
  "drug_name" : "EVEROLIMUS 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "845512",
  "drug_name" : "EVEROLIMUS 10 MG ORAL TABLET [AFINITOR]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "845515",
  "drug_name" : "EVEROLIMUS 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "846378",
  "drug_name" : "24 HR LEVETIRACETAM 750 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "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" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "847199",
  "drug_name" : "3 ML INSULIN ISOPHANE, HUMAN 100 UNT\\/ML PEN INJECTOR [HUMULIN N]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "847245",
  "drug_name" : "1.5 ML SOMATROPIN 10 MG\\/ML PEN INJECTOR [NORDITROPIN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "847247",
  "drug_name" : "1.5 ML SOMATROPIN 3.33 MG\\/ML PEN INJECTOR [NORDITROPIN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "847348",
  "drug_name" : "1.5 ML SOMATROPIN 6.67 MG\\/ML PEN INJECTOR [NORDITROPIN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "847617",
  "drug_name" : "CALCIUM CHLORIDE 0.33 MG\\/ML \\/ POTASSIUM CHLORIDE 0.3 MG\\/ML \\/ SODIUM CHLORIDE 8.6 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "847621",
  "drug_name" : "CALCIUM CHLORIDE 0.33 MG\\/ML \\/ POTASSIUM CHLORIDE 0.3 MG\\/ML \\/ SODIUM CHLORIDE 8.6 MG\\/ML IRRIGATION SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "847626",
  "drug_name" : "CALCIUM CHLORIDE 0.2 MG\\/ML \\/ GLUCOSE 50 MG\\/ML \\/ POTASSIUM CHLORIDE 1.79 MG\\/ML \\/ SODIUM CHLORIDE 6 MG\\/ML \\/ SODIUM LACTATE 3.1 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "847627",
  "drug_name" : "CALCIUM CHLORIDE 0.2 MG\\/ML \\/ GLUCOSE 50 MG\\/ML \\/ POTASSIUM CHLORIDE 0.3 MG\\/ML \\/ SODIUM CHLORIDE 6 MG\\/ML \\/ SODIUM LACTATE 3.1 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "847628",
  "drug_name" : "CALCIUM CHLORIDE 0.2 MG\\/ML \\/ POTASSIUM CHLORIDE 0.3 MG\\/ML \\/ SODIUM CHLORIDE 6 MG\\/ML \\/ SODIUM LACTATE 3.1 MG\\/ML IRRIGATION SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "847630",
  "drug_name" : "CALCIUM CHLORIDE 0.2 MG\\/ML \\/ POTASSIUM CHLORIDE 0.3 MG\\/ML \\/ SODIUM CHLORIDE 6 MG\\/ML \\/ SODIUM LACTATE 3.1 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "847734",
  "drug_name" : "ARTEMETHER 20 MG \\/ LUMEFANTRINE 120 MG ORAL TABLET [COARTEM]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "847749",
  "drug_name" : "LOPINAVIR 80 MG\\/ML \\/ RITONAVIR 20 MG\\/ML ORAL SOLUTION [KALETRA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "848164",
  "drug_name" : "0.5 ML GOLIMUMAB 100 MG\\/ML PREFILLED SYRINGE [SIMPONI]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "848176",
  "drug_name" : "AUGMENTED BETAMETHASONE 0.5 MG\\/ML TOPICAL CREAM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "848178",
  "drug_name" : "AUGMENTED BETAMETHASONE 0.5 MG\\/ML TOPICAL LOTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "848180",
  "drug_name" : "AUGMENTED BETAMETHASONE 0.0005 MG\\/MG TOPICAL OINTMENT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "848208",
  "drug_name" : "AUGMENTED BETAMETHASONE 0.0005 MG\\/MG TOPICAL GEL",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "848330",
  "drug_name" : "90 DAY ESTRADIOL 0.000313 MG\\/HR VAGINAL SYSTEM [ESTRING]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "848582",
  "drug_name" : "24 HR ROPINIROLE 6 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "848726",
  "drug_name" : "ILOPERIDONE 1 MG ORAL TABLET [FANAPT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "848730",
  "drug_name" : "ILOPERIDONE 10 MG ORAL TABLET [FANAPT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "848734",
  "drug_name" : "ILOPERIDONE 12 MG ORAL TABLET [FANAPT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "848738",
  "drug_name" : "ILOPERIDONE 2 MG ORAL TABLET [FANAPT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "848742",
  "drug_name" : "ILOPERIDONE 4 MG ORAL TABLET [FANAPT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "848746",
  "drug_name" : "ILOPERIDONE 6 MG ORAL TABLET [FANAPT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "848750",
  "drug_name" : "ILOPERIDONE 8 MG ORAL TABLET [FANAPT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "848752",
  "drug_name" : "FANAPT TITRATION PACK A",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "848943",
  "drug_name" : "CHOLESTYRAMINE RESIN 4000 MG POWDER FOR ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "848951",
  "drug_name" : "SUGAR-FREE CHOLESTYRAMINE RESIN 4000 MG POWDER FOR ORAL SUSPENSION [PREVALITE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "849385",
  "drug_name" : "AMANTADINE HYDROCHLORIDE 10 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "849389",
  "drug_name" : "AMANTADINE HYDROCHLORIDE 100 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "849395",
  "drug_name" : "AMANTADINE HYDROCHLORIDE 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "849501",
  "drug_name" : "DESMOPRESSIN ACETATE 0.004 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "849506",
  "drug_name" : "DESMOPRESSIN ACETATE 0.01 MG\\/ACTUAT NASAL SPRAY",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "849515",
  "drug_name" : "DESMOPRESSIN ACETATE 0.1 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "849599",
  "drug_name" : "1 ML CERTOLIZUMAB PEGOL 200 MG\\/ML PREFILLED SYRINGE [CIMZIA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "849827",
  "drug_name" : "HYPONATREMIA TOLVAPTAN 15 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "849833",
  "drug_name" : "HYPONATREMIA TOLVAPTAN 30 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "849928",
  "drug_name" : "CAFFEINE CITRATE 20 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "849931",
  "drug_name" : "3 ML CAFFEINE CITRATE 20 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "850087",
  "drug_name" : "24 HR LAMOTRIGINE 100 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "850091",
  "drug_name" : "24 HR LAMOTRIGINE 50 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "850457",
  "drug_name" : "DARUNAVIR 150 MG ORAL TABLET [PREZISTA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "851750",
  "drug_name" : "{7 (LAMOTRIGINE 100 MG DISINTEGRATING ORAL TABLET) \\/ 14 (LAMOTRIGINE 25 MG DISINTEGRATING ORAL TABLET) \\/ 14 (LAMOTRIGINE 50 MG DISINTEGRATING ORAL TABLET) } PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "852877",
  "drug_name" : "QUINIDINE SULFATE 200 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "852913",
  "drug_name" : "QUINIDINE SULFATE 300 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "852920",
  "drug_name" : "QUINIDINE GLUCONATE 324 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "853201",
  "drug_name" : "24 HR QUETIAPINE 50 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "853354",
  "drug_name" : "0.5 ML USTEKINUMAB 90 MG\\/ML PREFILLED SYRINGE [STELARA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "853356",
  "drug_name" : "1 ML USTEKINUMAB 90 MG\\/ML PREFILLED SYRINGE [STELARA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "854140",
  "drug_name" : "TAPENTADOL 100 MG ORAL TABLET [NUCYNTA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "854228",
  "drug_name" : "0.3 ML ENOXAPARIN SODIUM 100 MG\\/ML PREFILLED SYRINGE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "854232",
  "drug_name" : "0.3 ML ENOXAPARIN SODIUM 100 MG\\/ML PREFILLED SYRINGE [LOVENOX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "854235",
  "drug_name" : "0.4 ML ENOXAPARIN SODIUM 100 MG\\/ML PREFILLED SYRINGE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "854236",
  "drug_name" : "0.4 ML ENOXAPARIN SODIUM 100 MG\\/ML PREFILLED SYRINGE [LOVENOX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "854238",
  "drug_name" : "0.6 ML ENOXAPARIN SODIUM 100 MG\\/ML PREFILLED SYRINGE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "854239",
  "drug_name" : "0.6 ML ENOXAPARIN SODIUM 100 MG\\/ML PREFILLED SYRINGE [LOVENOX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "854241",
  "drug_name" : "0.8 ML ENOXAPARIN SODIUM 100 MG\\/ML PREFILLED SYRINGE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "854242",
  "drug_name" : "0.8 ML ENOXAPARIN SODIUM 100 MG\\/ML PREFILLED SYRINGE [LOVENOX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "854245",
  "drug_name" : "0.8 ML ENOXAPARIN SODIUM 150 MG\\/ML PREFILLED SYRINGE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "854247",
  "drug_name" : "0.8 ML ENOXAPARIN SODIUM 150 MG\\/ML PREFILLED SYRINGE [LOVENOX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "854248",
  "drug_name" : "1 ML ENOXAPARIN SODIUM 100 MG\\/ML PREFILLED SYRINGE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "854249",
  "drug_name" : "1 ML ENOXAPARIN SODIUM 100 MG\\/ML PREFILLED SYRINGE [LOVENOX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "854252",
  "drug_name" : "1 ML ENOXAPARIN SODIUM 150 MG\\/ML PREFILLED SYRINGE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "854253",
  "drug_name" : "1 ML ENOXAPARIN SODIUM 150 MG\\/ML PREFILLED SYRINGE [LOVENOX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "854255",
  "drug_name" : "ENOXAPARIN SODIUM 100 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "854256",
  "drug_name" : "ENOXAPARIN SODIUM 100 MG\\/ML INJECTABLE SOLUTION [LOVENOX]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "854302",
  "drug_name" : "1.5 ML SOMATROPIN 6.67 MG\\/ML CARTRIDGE [OMNITROPE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "854801",
  "drug_name" : "DICLOFENAC SODIUM 1 MG\\/ML OPHTHALMIC SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "854830",
  "drug_name" : "LISDEXAMFETAMINE DIMESYLATE 20 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "854834",
  "drug_name" : "LISDEXAMFETAMINE DIMESYLATE 30 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "854838",
  "drug_name" : "LISDEXAMFETAMINE DIMESYLATE 40 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "854842",
  "drug_name" : "LISDEXAMFETAMINE DIMESYLATE 70 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "854846",
  "drug_name" : "LISDEXAMFETAMINE DIMESYLATE 60 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "854850",
  "drug_name" : "LISDEXAMFETAMINE DIMESYLATE 50 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "854859",
  "drug_name" : "DRONEDARONE 400 MG ORAL TABLET [MULTAQ]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "854873",
  "drug_name" : "ZOLPIDEM TARTRATE 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "854876",
  "drug_name" : "ZOLPIDEM TARTRATE 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "854901",
  "drug_name" : "BISOPROLOL FUMARATE 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "854905",
  "drug_name" : "BISOPROLOL FUMARATE 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "854908",
  "drug_name" : "BISOPROLOL FUMARATE 10 MG \\/ HYDROCHLOROTHIAZIDE 6.25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "854916",
  "drug_name" : "BISOPROLOL FUMARATE 2.5 MG \\/ HYDROCHLOROTHIAZIDE 6.25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "854919",
  "drug_name" : "BISOPROLOL FUMARATE 5 MG \\/ HYDROCHLOROTHIAZIDE 6.25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "855168",
  "drug_name" : "LEVOCETIRIZINE DIHYDROCHLORIDE 0.5 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "855172",
  "drug_name" : "LEVOCETIRIZINE DIHYDROCHLORIDE 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "855178",
  "drug_name" : "TOLTERODINE TARTRATE 1 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "855194",
  "drug_name" : "TOLTERODINE TARTRATE 2 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "855288",
  "drug_name" : "WARFARIN SODIUM 1 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "855292",
  "drug_name" : "WARFARIN SODIUM 1 MG ORAL TABLET [JANTOVEN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "855296",
  "drug_name" : "WARFARIN SODIUM 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "855300",
  "drug_name" : "WARFARIN SODIUM 10 MG ORAL TABLET [JANTOVEN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "855302",
  "drug_name" : "WARFARIN SODIUM 2 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "855306",
  "drug_name" : "WARFARIN SODIUM 2 MG ORAL TABLET [JANTOVEN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "855312",
  "drug_name" : "WARFARIN SODIUM 2.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "855316",
  "drug_name" : "WARFARIN SODIUM 2.5 MG ORAL TABLET [JANTOVEN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "855318",
  "drug_name" : "WARFARIN SODIUM 3 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "855322",
  "drug_name" : "WARFARIN SODIUM 3 MG ORAL TABLET [JANTOVEN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "855324",
  "drug_name" : "WARFARIN SODIUM 4 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "855328",
  "drug_name" : "WARFARIN SODIUM 4 MG ORAL TABLET [JANTOVEN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "855332",
  "drug_name" : "WARFARIN SODIUM 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "855336",
  "drug_name" : "WARFARIN SODIUM 5 MG ORAL TABLET [JANTOVEN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "855338",
  "drug_name" : "WARFARIN SODIUM 6 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "855342",
  "drug_name" : "WARFARIN SODIUM 6 MG ORAL TABLET [JANTOVEN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "855344",
  "drug_name" : "WARFARIN SODIUM 7.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "855348",
  "drug_name" : "WARFARIN SODIUM 7.5 MG ORAL TABLET [JANTOVEN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "855474",
  "drug_name" : "ALCLOMETASONE DIPROPIONATE 0.5 MG\\/ML TOPICAL CREAM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "855480",
  "drug_name" : "ALCLOMETASONE DIPROPIONATE 0.0005 MG\\/MG TOPICAL OINTMENT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "855633",
  "drug_name" : "DICLOFENAC SODIUM 0.01 MG\\/MG TOPICAL GEL",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "855642",
  "drug_name" : "DICLOFENAC SODIUM 0.03 MG\\/MG TOPICAL GEL",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "855664",
  "drug_name" : "DICLOFENAC SODIUM 25 MG DELAYED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "855671",
  "drug_name" : "PHENYTOIN SODIUM 100 MG EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "855673",
  "drug_name" : "PHENYTOIN SODIUM 100 MG EXTENDED RELEASE ORAL CAPSULE [DILANTIN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "855812",
  "drug_name" : "PRASUGREL 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "855818",
  "drug_name" : "PRASUGREL 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "855856",
  "drug_name" : "3 ML APOMORPHINE HYDROCHLORIDE 10 MG\\/ML CARTRIDGE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "855858",
  "drug_name" : "3 ML APOMORPHINE HYDROCHLORIDE 10 MG\\/ML CARTRIDGE [APOKYN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "855861",
  "drug_name" : "PHENYTOIN SODIUM 200 MG EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "855863",
  "drug_name" : "PHENYTOIN SODIUM 200 MG EXTENDED RELEASE ORAL CAPSULE [PHENYTEK]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "855871",
  "drug_name" : "PHENYTOIN SODIUM 30 MG EXTENDED RELEASE ORAL CAPSULE [DILANTIN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "855873",
  "drug_name" : "PHENYTOIN SODIUM 300 MG EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "855875",
  "drug_name" : "PHENYTOIN SODIUM 300 MG EXTENDED RELEASE ORAL CAPSULE [PHENYTEK]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "855906",
  "drug_name" : "DICLOFENAC SODIUM 50 MG DELAYED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "855926",
  "drug_name" : "DICLOFENAC SODIUM 75 MG DELAYED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "856364",
  "drug_name" : "TRAZODONE HYDROCHLORIDE 150 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "856369",
  "drug_name" : "TRAZODONE HYDROCHLORIDE 300 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "856373",
  "drug_name" : "TRAZODONE HYDROCHLORIDE 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "856377",
  "drug_name" : "TRAZODONE HYDROCHLORIDE 50 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "856443",
  "drug_name" : "1 ML PROPRANOLOL HYDROCHLORIDE 1 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "856448",
  "drug_name" : "PROPRANOLOL HYDROCHLORIDE 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "856457",
  "drug_name" : "PROPRANOLOL HYDROCHLORIDE 20 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "856460",
  "drug_name" : "24 HR PROPRANOLOL HYDROCHLORIDE 120 MG EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "856467",
  "drug_name" : "TRI-LO-SPRINTEC 28 DAY PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "856481",
  "drug_name" : "24 HR PROPRANOLOL HYDROCHLORIDE 160 MG EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "856519",
  "drug_name" : "PROPRANOLOL HYDROCHLORIDE 40 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "856535",
  "drug_name" : "24 HR PROPRANOLOL HYDROCHLORIDE 60 MG EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "856556",
  "drug_name" : "PROPRANOLOL HYDROCHLORIDE 60 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "856569",
  "drug_name" : "24 HR PROPRANOLOL HYDROCHLORIDE 80 MG EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "856578",
  "drug_name" : "PROPRANOLOL HYDROCHLORIDE 80 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "856605",
  "drug_name" : "RIMANTADINE HYDROCHLORIDE 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "856652",
  "drug_name" : "DANTROLENE SODIUM 100 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "856656",
  "drug_name" : "DANTROLENE SODIUM 25 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "856660",
  "drug_name" : "DANTROLENE SODIUM 50 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "856666",
  "drug_name" : "RIFAXIMIN 550 MG ORAL TABLET [XIFAXAN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "856706",
  "drug_name" : "AMITRIPTYLINE HYDROCHLORIDE 10 MG \\/ PERPHENAZINE 2 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "856720",
  "drug_name" : "AMITRIPTYLINE HYDROCHLORIDE 10 MG \\/ PERPHENAZINE 4 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "856724",
  "drug_name" : "PROPRANOLOL HYDROCHLORIDE 4 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "856733",
  "drug_name" : "PROPRANOLOL HYDROCHLORIDE 8 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "856762",
  "drug_name" : "AMITRIPTYLINE HYDROCHLORIDE 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "856769",
  "drug_name" : "AMITRIPTYLINE HYDROCHLORIDE 12.5 MG \\/ CHLORDIAZEPOXIDE 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "856773",
  "drug_name" : "AMITRIPTYLINE HYDROCHLORIDE 150 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "856783",
  "drug_name" : "AMITRIPTYLINE HYDROCHLORIDE 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "856792",
  "drug_name" : "AMITRIPTYLINE HYDROCHLORIDE 25 MG \\/ CHLORDIAZEPOXIDE 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "856797",
  "drug_name" : "AMITRIPTYLINE HYDROCHLORIDE 25 MG \\/ PERPHENAZINE 2 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "856825",
  "drug_name" : "AMITRIPTYLINE HYDROCHLORIDE 25 MG \\/ PERPHENAZINE 4 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "856834",
  "drug_name" : "AMITRIPTYLINE HYDROCHLORIDE 25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "856840",
  "drug_name" : "AMITRIPTYLINE HYDROCHLORIDE 50 MG \\/ PERPHENAZINE 4 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "856845",
  "drug_name" : "AMITRIPTYLINE HYDROCHLORIDE 50 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "856853",
  "drug_name" : "AMITRIPTYLINE HYDROCHLORIDE 75 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "856940",
  "drug_name" : "ACETAMINOPHEN 21.7 MG\\/ML \\/ HYDROCODONE BITARTRATE 0.5 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "856999",
  "drug_name" : "ACETAMINOPHEN 325 MG \\/ HYDROCODONE BITARTRATE 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "857002",
  "drug_name" : "ACETAMINOPHEN 325 MG \\/ HYDROCODONE BITARTRATE 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "857005",
  "drug_name" : "ACETAMINOPHEN 325 MG \\/ HYDROCODONE BITARTRATE 7.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "857297",
  "drug_name" : "CLOMIPRAMINE HYDROCHLORIDE 25 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "857301",
  "drug_name" : "CLOMIPRAMINE HYDROCHLORIDE 50 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "857305",
  "drug_name" : "CLOMIPRAMINE HYDROCHLORIDE 75 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "857321",
  "drug_name" : "BETHANECHOL CHLORIDE 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "857328",
  "drug_name" : "BETHANECHOL CHLORIDE 25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "857336",
  "drug_name" : "BETHANECHOL CHLORIDE 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "857340",
  "drug_name" : "BETHANECHOL CHLORIDE 50 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "857560",
  "drug_name" : "TROSPIUM CHLORIDE 20 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "857635",
  "drug_name" : "1 ML TERBUTALINE SULFATE 1 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "857677",
  "drug_name" : "TERBUTALINE SULFATE 2.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "857683",
  "drug_name" : "TERBUTALINE SULFATE 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "857700",
  "drug_name" : "DICLOFENAC SODIUM 15 MG\\/ML TOPICAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "857799",
  "drug_name" : "TREPROSTINIL 0.6 MG\\/ML INHALATION SOLUTION [TYVASO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "857886",
  "drug_name" : "PROCAINAMIDE HYDROCHLORIDE 100 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "857962",
  "drug_name" : "PROCAINAMIDE HYDROCHLORIDE 500 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "858036",
  "drug_name" : "SAXAGLIPTIN 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "858042",
  "drug_name" : "SAXAGLIPTIN 2.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "858051",
  "drug_name" : "0.5 ML PALIPERIDONE PALMITATE 156 MG\\/ML PREFILLED SYRINGE [INVEGA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "858053",
  "drug_name" : "1.5 ML PALIPERIDONE PALMITATE 156 MG\\/ML PREFILLED SYRINGE [INVEGA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "858055",
  "drug_name" : "1 ML PALIPERIDONE PALMITATE 156 MG\\/ML PREFILLED SYRINGE [INVEGA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "858057",
  "drug_name" : "0.75 ML PALIPERIDONE PALMITATE 156 MG\\/ML PREFILLED SYRINGE [INVEGA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "858074",
  "drug_name" : "0.25 ML PALIPERIDONE PALMITATE 156 MG\\/ML PREFILLED SYRINGE [INVEGA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "858125",
  "drug_name" : "DEGARELIX 80 MG INJECTION [FIRMAGON]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "858127",
  "drug_name" : "DEGARELIX 120 MG INJECTION [FIRMAGON]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "858607",
  "drug_name" : "10 ML NICARDIPINE HYDROCHLORIDE 2.5 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "858625",
  "drug_name" : "PRAMIPEXOLE DIHYDROCHLORIDE 0.75 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "858733",
  "drug_name" : "URSODIOL 500 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "858747",
  "drug_name" : "URSODIOL 300 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "858751",
  "drug_name" : "URSODIOL 250 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "858804",
  "drug_name" : "ENALAPRIL MALEATE 2.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "858810",
  "drug_name" : "ENALAPRIL MALEATE 20 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "858813",
  "drug_name" : "ENALAPRIL MALEATE 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "858817",
  "drug_name" : "ENALAPRIL MALEATE 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "859033",
  "drug_name" : "PRAMIPEXOLE DIHYDROCHLORIDE 0.125 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "859040",
  "drug_name" : "PRAMIPEXOLE DIHYDROCHLORIDE 0.25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "859044",
  "drug_name" : "PRAMIPEXOLE DIHYDROCHLORIDE 0.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "859048",
  "drug_name" : "PRAMIPEXOLE DIHYDROCHLORIDE 1.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "859052",
  "drug_name" : "PRAMIPEXOLE DIHYDROCHLORIDE 1 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "859186",
  "drug_name" : "SELEGILINE HYDROCHLORIDE 5 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "859192",
  "drug_name" : "SELEGILINE HYDROCHLORIDE 1.25 MG DISINTEGRATING ORAL TABLET [ZELAPAR]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "859193",
  "drug_name" : "SELEGILINE HYDROCHLORIDE 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "859419",
  "drug_name" : "ROSUVASTATIN CALCIUM 40 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "859424",
  "drug_name" : "ROSUVASTATIN CALCIUM 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "859747",
  "drug_name" : "ROSUVASTATIN CALCIUM 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "859751",
  "drug_name" : "ROSUVASTATIN CALCIUM 20 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "859824",
  "drug_name" : "FLUPHENAZINE DECANOATE 25 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "859835",
  "drug_name" : "FLUPHENAZINE HYDROCHLORIDE 0.5 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "859841",
  "drug_name" : "FLUPHENAZINE HYDROCHLORIDE 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "859867",
  "drug_name" : "HALOPERIDOL DECANOATE 50 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "859871",
  "drug_name" : "HALOPERIDOL DECANOATE 100 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "859975",
  "drug_name" : "ASENAPINE 10 MG SUBLINGUAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "859981",
  "drug_name" : "ASENAPINE 5 MG SUBLINGUAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "860092",
  "drug_name" : "1 ML KETOROLAC TROMETHAMINE 15 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "860103",
  "drug_name" : "KETOROLAC TROMETHAMINE 4 MG\\/ML OPHTHALMIC SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "860107",
  "drug_name" : "KETOROLAC TROMETHAMINE 5 MG\\/ML OPHTHALMIC SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "860215",
  "drug_name" : "MEGESTROL ACETATE 20 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "860221",
  "drug_name" : "MEGESTROL ACETATE 40 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "860225",
  "drug_name" : "MEGESTROL ACETATE 40 MG\\/ML ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "860695",
  "drug_name" : "24 HR GALANTAMINE HYDROBROMIDE 16 MG EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "860707",
  "drug_name" : "24 HR GALANTAMINE HYDROBROMIDE 24 MG EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "860715",
  "drug_name" : "24 HR GALANTAMINE HYDROBROMIDE 8 MG EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "860805",
  "drug_name" : "AZELASTINE HYDROCHLORIDE 0.5 MG\\/ML OPHTHALMIC SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "860901",
  "drug_name" : "GALANTAMINE HYDROBROMIDE 4 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "860918",
  "drug_name" : "FLUPHENAZINE HYDROCHLORIDE 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "860975",
  "drug_name" : "24 HR METFORMIN HYDROCHLORIDE 500 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "860981",
  "drug_name" : "24 HR METFORMIN HYDROCHLORIDE 750 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "861004",
  "drug_name" : "METFORMIN HYDROCHLORIDE 1000 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "861007",
  "drug_name" : "METFORMIN HYDROCHLORIDE 500 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "861010",
  "drug_name" : "METFORMIN HYDROCHLORIDE 850 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "861043",
  "drug_name" : "2.7 ML PRAMLINTIDE ACETATE 1 MG\\/ML PEN INJECTOR [SYMLIN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "861045",
  "drug_name" : "1.5 ML PRAMLINTIDE ACETATE 1 MG\\/ML PEN INJECTOR [SYMLIN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "861064",
  "drug_name" : "SERTRALINE 20 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "861132",
  "drug_name" : "24 HR ALFUZOSIN HYDROCHLORIDE 10 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "861200",
  "drug_name" : "BRIMONIDINE TARTRATE 2 MG\\/ML OPHTHALMIC SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "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" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "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" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "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" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "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" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "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" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "861237",
  "drug_name" : "24 HR AMPHETAMINE ASPARTATE 1.25 MG \\/ AMPHETAMINE SULFATE 1.25 MG \\/ DEXTROAMPHETAMINE SACCHARATE 1.25 MG \\/ DEXTROAMPHETAMINE SULFATE 1.25 MG EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "861353",
  "drug_name" : "CLOBETASOL PROPIONATE 0.5 MG\\/ML TOPICAL FOAM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "861356",
  "drug_name" : "0.8 ML FONDAPARINUX SODIUM 12.5 MG\\/ML PREFILLED SYRINGE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "861360",
  "drug_name" : "0.5 ML FONDAPARINUX SODIUM 5 MG\\/ML PREFILLED SYRINGE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "861363",
  "drug_name" : "0.4 ML FONDAPARINUX SODIUM 12.5 MG\\/ML PREFILLED SYRINGE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "861365",
  "drug_name" : "0.6 ML FONDAPARINUX SODIUM 12.5 MG\\/ML PREFILLED SYRINGE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "861370",
  "drug_name" : "SEVELAMER CARBONATE 2400 MG POWDER FOR ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "861375",
  "drug_name" : "SEVELAMER CARBONATE 800 MG POWDER FOR ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "861402",
  "drug_name" : "PHENOXYBENZAMINE HYDROCHLORIDE 10 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "861424",
  "drug_name" : "PROPAFENONE HYDROCHLORIDE 150 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "861427",
  "drug_name" : "PROPAFENONE HYDROCHLORIDE 225 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "861430",
  "drug_name" : "PROPAFENONE HYDROCHLORIDE 300 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "861434",
  "drug_name" : "CLOBETASOL PROPIONATE 0.0005 MG\\/MG TOPICAL GEL",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "861448",
  "drug_name" : "CLOBETASOL PROPIONATE 0.0005 MG\\/MG TOPICAL OINTMENT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "861487",
  "drug_name" : "CLOBETASOL PROPIONATE 0.5 MG\\/ML TOPICAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "861490",
  "drug_name" : "CLOBETASOL PROPIONATE 0.5 MG\\/ML MEDICATED SHAMPOO",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "861495",
  "drug_name" : "CLOBETASOL PROPIONATE 0.5 MG\\/ML TOPICAL CREAM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "861505",
  "drug_name" : "CLOBETASOL PROPIONATE 0.5 MG\\/ML TOPICAL LOTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "861512",
  "drug_name" : "CLOBETASOL PROPIONATE 0.5 MG\\/ML TOPICAL SPRAY",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "861597",
  "drug_name" : "PENTAMIDINE ISETHIONATE 50 MG\\/ML INHALATION SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "861601",
  "drug_name" : "PENTAMIDINE ISETHIONATE 300 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "861657",
  "drug_name" : "24 HR NITROGLYCERIN 0.1 MG\\/HR TRANSDERMAL SYSTEM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "861668",
  "drug_name" : "DIHYDROERGOTAMINE MESYLATE 0.5 MG\\/ACTUAT METERED DOSE NASAL SPRAY",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "861672",
  "drug_name" : "1 ML DIHYDROERGOTAMINE MESYLATE 1 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "861731",
  "drug_name" : "GLIPIZIDE 2.5 MG \\/ METFORMIN HYDROCHLORIDE 250 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "861736",
  "drug_name" : "GLIPIZIDE 2.5 MG \\/ METFORMIN HYDROCHLORIDE 500 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "861740",
  "drug_name" : "GLIPIZIDE 5 MG \\/ METFORMIN HYDROCHLORIDE 500 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "861848",
  "drug_name" : "FLUPHENAZINE HYDROCHLORIDE 5 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "861960",
  "drug_name" : "ARMODAFINIL 200 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "862006",
  "drug_name" : "24 HR GUANFACINE 1 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "862013",
  "drug_name" : "24 HR GUANFACINE 2 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "862019",
  "drug_name" : "24 HR GUANFACINE 3 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "862025",
  "drug_name" : "24 HR GUANFACINE 4 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "863538",
  "drug_name" : "PENICILLIN G POTASSIUM 1000000 UNT\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "863559",
  "drug_name" : "VALGANCICLOVIR 50 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "863599",
  "drug_name" : "OXYBUTYNIN CHLORIDE 1 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "863606",
  "drug_name" : "ERYTHROMYCIN ETHYLSUCCINATE 400 MG ORAL TABLET [E.E.S.]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "863619",
  "drug_name" : "24 HR OXYBUTYNIN CHLORIDE 10 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "863628",
  "drug_name" : "24 HR OXYBUTYNIN CHLORIDE 15 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "863636",
  "drug_name" : "24 HR OXYBUTYNIN CHLORIDE 5 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "863664",
  "drug_name" : "OXYBUTYNIN CHLORIDE 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "863669",
  "drug_name" : "TAMSULOSIN HYDROCHLORIDE 0.4 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "863829",
  "drug_name" : "AMYLASE 120000 UNT \\/ LIPASE 24000 UNT \\/ PROTEASE 76000 UNT DELAYED RELEASE ORAL CAPSULE [CREON]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "863836",
  "drug_name" : "AMYLASE 30000 UNT \\/ LIPASE 6000 UNT \\/ PROTEASE 19000 UNT DELAYED RELEASE ORAL CAPSULE [CREON]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "863841",
  "drug_name" : "AMYLASE 60000 UNT \\/ LIPASE 12000 UNT \\/ PROTEASE 38000 UNT DELAYED RELEASE ORAL CAPSULE [CREON]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "864110",
  "drug_name" : "1.5 ML SOMATROPIN 3.3 MG\\/ML CARTRIDGE [OMNITROPE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "864675",
  "drug_name" : "ATOVAQUONE 250 MG \\/ PROGUANIL HYDROCHLORIDE 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "864681",
  "drug_name" : "ATOVAQUONE 62.5 MG \\/ PROGUANIL HYDROCHLORIDE 25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "864706",
  "drug_name" : "METHADONE HYDROCHLORIDE 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "864718",
  "drug_name" : "METHADONE HYDROCHLORIDE 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "864761",
  "drug_name" : "METHADONE HYDROCHLORIDE 1 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "865098",
  "drug_name" : "INSULIN LISPRO 100 UNT\\/ML INJECTABLE SOLUTION [HUMALOG]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "865117",
  "drug_name" : "FLUPHENAZINE HYDROCHLORIDE 1 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "865123",
  "drug_name" : "FLUPHENAZINE HYDROCHLORIDE 2.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "865129",
  "drug_name" : "FLUPHENAZINE HYDROCHLORIDE 2.5 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "865208",
  "drug_name" : "24 HR SELEGILINE 0.25 MG\\/HR TRANSDERMAL SYSTEM [EMSAM]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "865212",
  "drug_name" : "24 HR SELEGILINE 0.375 MG\\/HR TRANSDERMAL SYSTEM [EMSAM]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "865216",
  "drug_name" : "24 HR SELEGILINE 0.5 MG\\/HR TRANSDERMAL SYSTEM [EMSAM]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "866018",
  "drug_name" : "BUSPIRONE HYDROCHLORIDE 15 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "866021",
  "drug_name" : "CYPROHEPTADINE HYDROCHLORIDE 0.4 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "866042",
  "drug_name" : "NEOMYCIN SULFATE 500 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "866049",
  "drug_name" : "60 ACTUAT SALMETEROL 0.05 MG\\/ACTUAT DRY POWDER INHALER [SEREVENT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "866083",
  "drug_name" : "BUSPIRONE HYDROCHLORIDE 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "866090",
  "drug_name" : "BUSPIRONE HYDROCHLORIDE 30 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "866094",
  "drug_name" : "BUSPIRONE HYDROCHLORIDE 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "866103",
  "drug_name" : "24 HR PALIPERIDONE 1.5 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "866111",
  "drug_name" : "BUSPIRONE HYDROCHLORIDE 7.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "866144",
  "drug_name" : "CYPROHEPTADINE HYDROCHLORIDE 4 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "866412",
  "drug_name" : "24 HR METOPROLOL SUCCINATE 100 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "866419",
  "drug_name" : "24 HR METOPROLOL SUCCINATE 200 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "866427",
  "drug_name" : "24 HR METOPROLOL SUCCINATE 25 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "866436",
  "drug_name" : "24 HR METOPROLOL SUCCINATE 50 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "866491",
  "drug_name" : "HYDROCHLOROTHIAZIDE 50 MG \\/ METOPROLOL TARTRATE 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "866508",
  "drug_name" : "5 ML METOPROLOL TARTRATE 1 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "866511",
  "drug_name" : "METOPROLOL TARTRATE 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "866514",
  "drug_name" : "METOPROLOL TARTRATE 50 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "866910",
  "drug_name" : "COLESEVELAM HYDROCHLORIDE 625 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "866924",
  "drug_name" : "METOPROLOL TARTRATE 25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "867381",
  "drug_name" : "C1 ESTERASE INHIBITOR (HUMAN) 500 UNT INJECTION [BERINERT]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "867502",
  "drug_name" : "PAZOPANIB 200 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "876203",
  "drug_name" : "20 ML PERAMIVIR 10 MG\\/ML INJECTION [RAPIVAB]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "881341",
  "drug_name" : "ADEFOVIR DIPIVOXIL 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "883358",
  "drug_name" : "CALCITRIOL 0.000003 MG\\/MG TOPICAL OINTMENT [VECTICAL]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "883826",
  "drug_name" : "TRANEXAMIC ACID 650 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "884173",
  "drug_name" : "CLONIDINE HYDROCHLORIDE 0.1 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "884185",
  "drug_name" : "CLONIDINE HYDROCHLORIDE 0.2 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "884189",
  "drug_name" : "CLONIDINE HYDROCHLORIDE 0.3 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "884221",
  "drug_name" : "10 ML CLONIDINE HYDROCHLORIDE 0.1 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "884308",
  "drug_name" : "NYSTATIN 100 UNT\\/MG TOPICAL OINTMENT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "884385",
  "drug_name" : "DEXTROAMPHETAMINE SULFATE 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "884386",
  "drug_name" : "DEXTROAMPHETAMINE SULFATE 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "884520",
  "drug_name" : "DEXTROAMPHETAMINE SULFATE 10 MG EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "884532",
  "drug_name" : "DEXTROAMPHETAMINE SULFATE 15 MG EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "884535",
  "drug_name" : "DEXTROAMPHETAMINE SULFATE 5 MG EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "884617",
  "drug_name" : "ELTROMBOPAG 75 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "884707",
  "drug_name" : "ESTRADIOL 0.01 MG VAGINAL INSERT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "885205",
  "drug_name" : "2 ML BENZTROPINE MESYLATE 1 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "885209",
  "drug_name" : "BENZTROPINE MESYLATE 2 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "885213",
  "drug_name" : "BENZTROPINE MESYLATE 1 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "885219",
  "drug_name" : "BENZTROPINE MESYLATE 0.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "885857",
  "drug_name" : "BALSALAZIDE DISODIUM 750 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "886662",
  "drug_name" : "FLECAINIDE ACETATE 50 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "886666",
  "drug_name" : "FLECAINIDE ACETATE 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "886671",
  "drug_name" : "FLECAINIDE ACETATE 150 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "889614",
  "drug_name" : "CHLORDIAZEPOXIDE HYDROCHLORIDE 5 MG \\/ CLIDINIUM BROMIDE 2.5 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "890918",
  "drug_name" : "ESTRADIOL 0.1 MG\\/ML VAGINAL CREAM [ESTRACE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "891874",
  "drug_name" : "MORPHINE SULFATE 100 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "891881",
  "drug_name" : "MORPHINE SULFATE 15 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "891888",
  "drug_name" : "MORPHINE SULFATE 30 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "891893",
  "drug_name" : "MORPHINE SULFATE 60 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "892246",
  "drug_name" : "LEVOTHYROXINE SODIUM 0.1 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "892251",
  "drug_name" : "LEVOTHYROXINE SODIUM 0.2 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "892255",
  "drug_name" : "LEVOTHYROXINE SODIUM 0.3 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "892582",
  "drug_name" : "MORPHINE SULFATE 15 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "892589",
  "drug_name" : "MORPHINE SULFATE 2 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "892625",
  "drug_name" : "MORPHINE SULFATE 20 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "892646",
  "drug_name" : "MORPHINE SULFATE 200 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "892672",
  "drug_name" : "MORPHINE SULFATE 30 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "894780",
  "drug_name" : "MORPHINE SULFATE 4 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "894859",
  "drug_name" : "ACITRETIN 17.5 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "895487",
  "drug_name" : "FLUTICASONE PROPIONATE 0.00005 MG\\/MG TOPICAL OINTMENT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "895670",
  "drug_name" : "24 HR QUETIAPINE 150 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "895987",
  "drug_name" : "FLUTICASONE PROPIONATE 0.5 MG\\/ML TOPICAL CREAM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "895994",
  "drug_name" : "120 ACTUAT FLUTICASONE PROPIONATE 0.044 MG\\/ACTUAT METERED DOSE INHALER",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "896237",
  "drug_name" : "120 ACTUAT FLUTICASONE PROPIONATE 0.045 MG\\/ACTUAT \\/ SALMETEROL 0.021 MG\\/ACTUAT METERED DOSE INHALER [ADVAIR]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "896245",
  "drug_name" : "120 ACTUAT FLUTICASONE PROPIONATE 0.115 MG\\/ACTUAT \\/ SALMETEROL 0.021 MG\\/ACTUAT METERED DOSE INHALER [ADVAIR]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "896273",
  "drug_name" : "120 ACTUAT FLUTICASONE PROPIONATE 0.23 MG\\/ACTUAT \\/ SALMETEROL 0.021 MG\\/ACTUAT METERED DOSE INHALER [ADVAIR]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "896758",
  "drug_name" : "LABETALOL HYDROCHLORIDE 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "896762",
  "drug_name" : "LABETALOL HYDROCHLORIDE 200 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "896766",
  "drug_name" : "LABETALOL HYDROCHLORIDE 300 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "896771",
  "drug_name" : "LABETALOL HYDROCHLORIDE 5 MG\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "896854",
  "drug_name" : "CHORIONIC GONADOTROPIN 10000 UNT\\/ML INJECTABLE SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "897021",
  "drug_name" : "12 HR DALFAMPRIDINE 10 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "897122",
  "drug_name" : "3 ML LIRAGLUTIDE 6 MG\\/ML PEN INJECTOR",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "897640",
  "drug_name" : "VERAPAMIL HYDROCHLORIDE 180 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "897649",
  "drug_name" : "VERAPAMIL HYDROCHLORIDE 240 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "897657",
  "drug_name" : "HYDROMORPHONE HYDROCHLORIDE 1 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "897659",
  "drug_name" : "VERAPAMIL HYDROCHLORIDE 120 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "897666",
  "drug_name" : "VERAPAMIL HYDROCHLORIDE 120 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "897683",
  "drug_name" : "VERAPAMIL HYDROCHLORIDE 80 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "897696",
  "drug_name" : "HYDROMORPHONE HYDROCHLORIDE 2 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "897702",
  "drug_name" : "HYDROMORPHONE HYDROCHLORIDE 4 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "897710",
  "drug_name" : "HYDROMORPHONE HYDROCHLORIDE 8 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "897722",
  "drug_name" : "VERAPAMIL HYDROCHLORIDE 40 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "898342",
  "drug_name" : "AMLODIPINE 10 MG \\/ BENAZEPRIL HYDROCHLORIDE 20 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "898346",
  "drug_name" : "AMLODIPINE 10 MG \\/ BENAZEPRIL HYDROCHLORIDE 40 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "898350",
  "drug_name" : "AMLODIPINE 2.5 MG \\/ BENAZEPRIL HYDROCHLORIDE 10 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "898353",
  "drug_name" : "AMLODIPINE 5 MG \\/ BENAZEPRIL HYDROCHLORIDE 10 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "898356",
  "drug_name" : "AMLODIPINE 5 MG \\/ BENAZEPRIL HYDROCHLORIDE 20 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "898359",
  "drug_name" : "AMLODIPINE 5 MG \\/ BENAZEPRIL HYDROCHLORIDE 40 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "898490",
  "drug_name" : "POTASSIUM CITRATE 15 MEQ EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "898589",
  "drug_name" : "OCTREOTIDE 20 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "898591",
  "drug_name" : "OCTREOTIDE 20 MG INJECTION [SANDOSTATIN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "898601",
  "drug_name" : "OCTREOTIDE 30 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "898603",
  "drug_name" : "OCTREOTIDE 30 MG INJECTION [SANDOSTATIN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "898605",
  "drug_name" : "OCTREOTIDE 10 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "898607",
  "drug_name" : "OCTREOTIDE 10 MG INJECTION [SANDOSTATIN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "898687",
  "drug_name" : "BENAZEPRIL HYDROCHLORIDE 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "898690",
  "drug_name" : "BENAZEPRIL HYDROCHLORIDE 20 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "898715",
  "drug_name" : "PREGABALIN 20 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "898719",
  "drug_name" : "BENAZEPRIL HYDROCHLORIDE 40 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "898723",
  "drug_name" : "BENAZEPRIL HYDROCHLORIDE 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "899439",
  "drug_name" : "24 HR DEXMETHYLPHENIDATE HYDROCHLORIDE 10 MG EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "899461",
  "drug_name" : "24 HR DEXMETHYLPHENIDATE HYDROCHLORIDE 15 MG EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "899485",
  "drug_name" : "24 HR DEXMETHYLPHENIDATE HYDROCHLORIDE 20 MG EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "899495",
  "drug_name" : "24 HR DEXMETHYLPHENIDATE HYDROCHLORIDE 30 MG EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "899511",
  "drug_name" : "24 HR DEXMETHYLPHENIDATE HYDROCHLORIDE 5 MG EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "899518",
  "drug_name" : "DEXMETHYLPHENIDATE HYDROCHLORIDE 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "899548",
  "drug_name" : "DEXMETHYLPHENIDATE HYDROCHLORIDE 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "899557",
  "drug_name" : "DEXMETHYLPHENIDATE HYDROCHLORIDE 2.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "899690",
  "drug_name" : "24 HR NITROGLYCERIN 0.3 MG\\/HR TRANSDERMAL SYSTEM [NITRO-DUR]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "899705",
  "drug_name" : "24 HR NITROGLYCERIN 0.8 MG\\/HR TRANSDERMAL SYSTEM [NITRO-DUR]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "900156",
  "drug_name" : "24 HR LAMOTRIGINE 200 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "900164",
  "drug_name" : "24 HR LAMOTRIGINE 25 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "900575",
  "drug_name" : "RITONAVIR 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "901518",
  "drug_name" : "[MENVEO]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-6",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "901614",
  "drug_name" : "AZTREONAM 75 MG\\/ML INHALATION SOLUTION [CAYSTON]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "901812",
  "drug_name" : "VELAGLUCERASE ALFA 400 UNT INJECTION [VPRIV]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "902648",
  "drug_name" : "12 HR DISOPYRAMIDE 100 MG EXTENDED RELEASE ORAL CAPSULE [NORPACE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "902652",
  "drug_name" : "12 HR DISOPYRAMIDE 150 MG EXTENDED RELEASE ORAL CAPSULE [NORPACE]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "903456",
  "drug_name" : "LIOTHYRONINE SODIUM 0.005 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "903697",
  "drug_name" : "LIOTHYRONINE SODIUM 0.025 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "903703",
  "drug_name" : "LIOTHYRONINE SODIUM 0.05 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "903843",
  "drug_name" : "PYRIDOSTIGMINE BROMIDE 12 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "903847",
  "drug_name" : "PYRIDOSTIGMINE BROMIDE 180 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "903855",
  "drug_name" : "2 ML PYRIDOSTIGMINE BROMIDE 5 MG\\/ML INJECTION [REGONOL]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-3",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "903857",
  "drug_name" : "PYRIDOSTIGMINE BROMIDE 60 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "903873",
  "drug_name" : "24 HR FLUVOXAMINE MALEATE 100 MG EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "903879",
  "drug_name" : "24 HR FLUVOXAMINE MALEATE 150 MG EXTENDED RELEASE ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "903884",
  "drug_name" : "FLUVOXAMINE MALEATE 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "903887",
  "drug_name" : "FLUVOXAMINE MALEATE 25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "903891",
  "drug_name" : "FLUVOXAMINE MALEATE 50 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "904170",
  "drug_name" : "PRIMAQUINE PHOSPHATE 26.3 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "904396",
  "drug_name" : "ALENDRONIC ACID 35 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "904419",
  "drug_name" : "ALENDRONIC ACID 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "904431",
  "drug_name" : "ALENDRONIC ACID 70 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "904458",
  "drug_name" : "PRAVASTATIN SODIUM 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "904467",
  "drug_name" : "PRAVASTATIN SODIUM 20 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "904475",
  "drug_name" : "PRAVASTATIN SODIUM 40 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "904481",
  "drug_name" : "PRAVASTATIN SODIUM 80 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "904589",
  "drug_name" : "SOTALOL HYDROCHLORIDE 240 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "904870",
  "drug_name" : "168 HR BUPRENORPHINE 0.01 MG\\/HR TRANSDERMAL SYSTEM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "904876",
  "drug_name" : "168 HR BUPRENORPHINE 0.02 MG\\/HR TRANSDERMAL SYSTEM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "904880",
  "drug_name" : "168 HR BUPRENORPHINE 0.005 MG\\/HR TRANSDERMAL SYSTEM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "905057",
  "drug_name" : "TRIPTORELIN 22.5 MG INJECTION [TRELSTAR]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "905059",
  "drug_name" : "TRIPTORELIN 3.75 MG INJECTION [TRELSTAR]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "905064",
  "drug_name" : "TRIPTORELIN 11.25 MG INJECTION [TRELSTAR]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "905158",
  "drug_name" : "SIROLIMUS 0.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "905164",
  "drug_name" : "OLSALAZINE SODIUM 250 MG ORAL CAPSULE [DIPENTUM]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "905168",
  "drug_name" : "PROTRIPTYLINE HYDROCHLORIDE 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "905172",
  "drug_name" : "PROTRIPTYLINE HYDROCHLORIDE 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "905189",
  "drug_name" : "20 ML ROPIVACAINE HYDROCHLORIDE 7.5 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "905199",
  "drug_name" : "HYDRALAZINE HYDROCHLORIDE 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "905222",
  "drug_name" : "HYDRALAZINE HYDROCHLORIDE 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "905225",
  "drug_name" : "HYDRALAZINE HYDROCHLORIDE 25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "905269",
  "drug_name" : "TRIHEXYPHENIDYL HYDROCHLORIDE 2 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "905273",
  "drug_name" : "TRIHEXYPHENIDYL HYDROCHLORIDE 0.4 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "905283",
  "drug_name" : "TRIHEXYPHENIDYL HYDROCHLORIDE 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "905341",
  "drug_name" : "DEMECLOCYCLINE HYDROCHLORIDE 150 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "905347",
  "drug_name" : "DEMECLOCYCLINE HYDROCHLORIDE 300 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "905369",
  "drug_name" : "CHLORDIAZEPOXIDE HYDROCHLORIDE 10 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "905390",
  "drug_name" : "CARGLUMIC ACID 200 MG TABLET FOR ORAL SUSPENSION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "905395",
  "drug_name" : "HYDRALAZINE HYDROCHLORIDE 50 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "905495",
  "drug_name" : "CHLORDIAZEPOXIDE HYDROCHLORIDE 25 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "905516",
  "drug_name" : "CHLORDIAZEPOXIDE HYDROCHLORIDE 5 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "92758",
  "drug_name" : "GRISEOFULVIN 165 MG ORAL TABLET [FULVICIN P\\/G]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "96304",
  "drug_name" : "PRIMIDONE 250 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "966219",
  "drug_name" : "LEVOTHYROXINE SODIUM 0.5 MG INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "966220",
  "drug_name" : "LEVOTHYROXINE SODIUM 0.025 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "966221",
  "drug_name" : "LEVOTHYROXINE SODIUM 0.05 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "966222",
  "drug_name" : "LEVOTHYROXINE SODIUM 0.075 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "966224",
  "drug_name" : "LEVOTHYROXINE SODIUM 0.125 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "966225",
  "drug_name" : "LEVOTHYROXINE SODIUM 0.15 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "966248",
  "drug_name" : "LEVOTHYROXINE SODIUM 0.112 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "966249",
  "drug_name" : "LEVOTHYROXINE SODIUM 0.175 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "966253",
  "drug_name" : "LEVOTHYROXINE SODIUM 0.088 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "966270",
  "drug_name" : "LEVOTHYROXINE SODIUM 0.137 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "966571",
  "drug_name" : "1 ML HYDRALAZINE HYDROCHLORIDE 20 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "966607",
  "drug_name" : "DIFLORASONE DIACETATE 0.0005 MG\\/MG TOPICAL OINTMENT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "966787",
  "drug_name" : "DOXEPIN 3 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "966793",
  "drug_name" : "DOXEPIN 6 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "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" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "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" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "967023",
  "drug_name" : "POLYETHYLENE GLYCOL 3350 240000 MG \\/ POTASSIUM CHLORIDE 2980 MG \\/ SODIUM BICARBONATE 6720 MG \\/ SODIUM CHLORIDE 5840 MG \\/ SODIUM SULFATE 22720 MG POWDER FOR ORAL SOLUTION [GAVILYTE-C]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "967388",
  "drug_name" : "AMPHOTERICIN B LIPOSOMAL 50 MG INJECTION [AMBISOME]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "977427",
  "drug_name" : "EVEROLIMUS 0.25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "977434",
  "drug_name" : "EVEROLIMUS 0.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "977438",
  "drug_name" : "EVEROLIMUS 0.75 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : true,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "977880",
  "drug_name" : "AMILORIDE HYDROCHLORIDE 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "977883",
  "drug_name" : "AMILORIDE HYDROCHLORIDE 5 MG \\/ HYDROCHLOROTHIAZIDE 50 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "977978",
  "drug_name" : "HALOBETASOL PROPIONATE 0.0005 MG\\/MG TOPICAL OINTMENT",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "977990",
  "drug_name" : "HALOBETASOL PROPIONATE 0.5 MG\\/ML TOPICAL CREAM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "979092",
  "drug_name" : "HYDROXYCHLOROQUINE SULFATE 200 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "979115",
  "drug_name" : "0.6 ML METHYLNALTREXONE BROMIDE 20 MG\\/ML INJECTION [RELISTOR]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "979120",
  "drug_name" : "10 ML IBUTILIDE FUMARATE 0.1 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "979432",
  "drug_name" : "100 ML ESMOLOL HYDROCHLORIDE 20 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "979464",
  "drug_name" : "HYDROCHLOROTHIAZIDE 12.5 MG \\/ LOSARTAN POTASSIUM 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "979468",
  "drug_name" : "HYDROCHLOROTHIAZIDE 12.5 MG \\/ LOSARTAN POTASSIUM 50 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "979471",
  "drug_name" : "HYDROCHLOROTHIAZIDE 25 MG \\/ LOSARTAN POTASSIUM 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "979480",
  "drug_name" : "LOSARTAN POTASSIUM 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "979485",
  "drug_name" : "LOSARTAN POTASSIUM 25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "979492",
  "drug_name" : "LOSARTAN POTASSIUM 50 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "984105",
  "drug_name" : "SODIUM PHENYLBUTYRATE 0.94 MG\\/MG ORAL POWDER",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "991039",
  "drug_name" : "CHLORPROMAZINE HYDROCHLORIDE 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "991044",
  "drug_name" : "CHLORPROMAZINE HYDROCHLORIDE 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "991053",
  "drug_name" : "CHLORPROMAZINE HYDROCHLORIDE 100 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "991061",
  "drug_name" : "DICYCLOMINE HYDROCHLORIDE 10 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "991065",
  "drug_name" : "2 ML DICYCLOMINE HYDROCHLORIDE 10 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "991082",
  "drug_name" : "DICYCLOMINE HYDROCHLORIDE 2 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "991086",
  "drug_name" : "DICYCLOMINE HYDROCHLORIDE 20 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "991147",
  "drug_name" : "METHADONE HYDROCHLORIDE 10 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "991188",
  "drug_name" : "CHLORPROMAZINE HYDROCHLORIDE 200 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "991194",
  "drug_name" : "CHLORPROMAZINE HYDROCHLORIDE 25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "991332",
  "drug_name" : "CHLORPROMAZINE HYDROCHLORIDE 30 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "991336",
  "drug_name" : "CHLORPROMAZINE HYDROCHLORIDE 50 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "991722",
  "drug_name" : "ALPHA 1-PROTEINASE INHIBITOR, HUMAN 1 MG INJECTION [ZEMAIRA]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "992150",
  "drug_name" : "METHENAMINE HIPPURATE 1000 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "992395",
  "drug_name" : "GATIFLOXACIN 5 MG\\/ML OPHTHALMIC SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "992432",
  "drug_name" : "PROMETHAZINE HYDROCHLORIDE 1.25 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "992438",
  "drug_name" : "PROMETHAZINE HYDROCHLORIDE 12.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "992445",
  "drug_name" : "PROMETHAZINE HYDROCHLORIDE 12.5 MG RECTAL SUPPOSITORY [PROMETHEGAN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "992447",
  "drug_name" : "PROMETHAZINE HYDROCHLORIDE 25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "992459",
  "drug_name" : "PROMETHAZINE HYDROCHLORIDE 25 MG RECTAL SUPPOSITORY [PROMETHEGAN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "992460",
  "drug_name" : "1 ML PROMETHAZINE HYDROCHLORIDE 25 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "992475",
  "drug_name" : "PROMETHAZINE HYDROCHLORIDE 50 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "992809",
  "drug_name" : "20 ML CHLOROPROCAINE HYDROCHLORIDE 30 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "993072",
  "drug_name" : "ALGLUCOSIDASE ALFA 50 MG INJECTION [LUMIZYME]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "993462",
  "drug_name" : "MIDODRINE HYDROCHLORIDE 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "993466",
  "drug_name" : "MIDODRINE HYDROCHLORIDE 2.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "993470",
  "drug_name" : "MIDODRINE HYDROCHLORIDE 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "993503",
  "drug_name" : "12 HR BUPROPION HYDROCHLORIDE 100 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "993518",
  "drug_name" : "12 HR BUPROPION HYDROCHLORIDE 150 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "993536",
  "drug_name" : "12 HR BUPROPION HYDROCHLORIDE 200 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "993541",
  "drug_name" : "24 HR BUPROPION HYDROCHLORIDE 150 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "993557",
  "drug_name" : "24 HR BUPROPION HYDROCHLORIDE 300 MG EXTENDED RELEASE ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "993569",
  "drug_name" : "24 HR BUPROPION HYDROBROMIDE 348 MG EXTENDED RELEASE ORAL TABLET [APLENZIN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "993683",
  "drug_name" : "24 HR BUPROPION HYDROBROMIDE 522 MG EXTENDED RELEASE ORAL TABLET [APLENZIN]",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "993687",
  "drug_name" : "BUPROPION HYDROCHLORIDE 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "993691",
  "drug_name" : "BUPROPION HYDROCHLORIDE 75 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "993755",
  "drug_name" : "ACETAMINOPHEN 24 MG\\/ML \\/ CODEINE PHOSPHATE 2.4 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "993770",
  "drug_name" : "ACETAMINOPHEN 300 MG \\/ CODEINE PHOSPHATE 15 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "993781",
  "drug_name" : "ACETAMINOPHEN 300 MG \\/ CODEINE PHOSPHATE 30 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "993856",
  "drug_name" : "LACOSAMIDE 10 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-4",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "993890",
  "drug_name" : "ACETAMINOPHEN 300 MG \\/ CODEINE PHOSPHATE 60 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "995218",
  "drug_name" : "HYDROXYZINE HYDROCHLORIDE 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "995232",
  "drug_name" : "HYDROXYZINE PAMOATE 100 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "995241",
  "drug_name" : "HYDROXYZINE HYDROCHLORIDE 2 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "995253",
  "drug_name" : "HYDROXYZINE PAMOATE 25 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "995258",
  "drug_name" : "HYDROXYZINE HYDROCHLORIDE 25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "995270",
  "drug_name" : "1 ML HYDROXYZINE HYDROCHLORIDE 25 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "995278",
  "drug_name" : "HYDROXYZINE PAMOATE 50 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "995281",
  "drug_name" : "HYDROXYZINE HYDROCHLORIDE 50 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "995599",
  "drug_name" : "ETHAMBUTOL HYDROCHLORIDE 100 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "995607",
  "drug_name" : "ETHAMBUTOL HYDROCHLORIDE 400 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "995666",
  "drug_name" : "MECLIZINE HYDROCHLORIDE 25 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "995868",
  "drug_name" : "CODEINE PHOSPHATE 2 MG\\/ML \\/ GUAIFENESIN 20 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "996561",
  "drug_name" : "MEMANTINE HYDROCHLORIDE 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "996571",
  "drug_name" : "MEMANTINE HYDROCHLORIDE 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "996572",
  "drug_name" : "{21 (MEMANTINE HYDROCHLORIDE 10 MG ORAL TABLET) \\/ 28 (MEMANTINE HYDROCHLORIDE 5 MG ORAL TABLET) } PACK",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "996740",
  "drug_name" : "MEMANTINE HYDROCHLORIDE 2 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "996824",
  "drug_name" : "METHYLERGONOVINE MALEATE 0.2 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "996828",
  "drug_name" : "1 ML METHYLERGONOVINE MALEATE 0.2 MG\\/ML INJECTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "996921",
  "drug_name" : "CLOZAPINE 200 MG DISINTEGRATING ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "997010",
  "drug_name" : "QUININE SULFATE 324 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "997170",
  "drug_name" : "CODEINE SULFATE 15 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "997220",
  "drug_name" : "DONEPEZIL HYDROCHLORIDE 10 MG DISINTEGRATING ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "997223",
  "drug_name" : "DONEPEZIL HYDROCHLORIDE 10 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "997226",
  "drug_name" : "DONEPEZIL HYDROCHLORIDE 5 MG DISINTEGRATING ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "997229",
  "drug_name" : "DONEPEZIL HYDROCHLORIDE 5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-1",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "997287",
  "drug_name" : "CODEINE SULFATE 30 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "997296",
  "drug_name" : "CODEINE SULFATE 60 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "997653",
  "drug_name" : "NILOTINIB 150 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "998189",
  "drug_name" : "EVEROLIMUS 2.5 MG ORAL TABLET",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-5",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "998671",
  "drug_name" : "168 HR CLONIDINE 0.00417 MG\\/HR TRANSDERMAL SYSTEM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "998675",
  "drug_name" : "168 HR CLONIDINE 0.00833 MG\\/HR TRANSDERMAL SYSTEM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "998679",
  "drug_name" : "168 HR CLONIDINE 0.0125 MG\\/HR TRANSDERMAL SYSTEM",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "998685",
  "drug_name" : "ACEBUTOLOL 400 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "998689",
  "drug_name" : "ACEBUTOLOL 200 MG ORAL CAPSULE",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
}, {
  "rxnorm_id" : "999961",
  "drug_name" : "GLYCOPYRROLATE 0.2 MG\\/ML ORAL SOLUTION",
  "plans" : [ {
    "plan_id_type" : "Medicare QUEST Medicaid Plan Description",
    "plan_id" : "KP-HI Dual Complete HMO D-SNP",
    "drug_tier" : "TIER-2",
    "prior_authorization" : false,
    "step_therapy" : false,
    "quantity_limit" : false,
    "years" : [ 2025 ]
  } ]
} ]