[{"NDC_FORMAT_CODE":"00002143301","LABEL_NAME":"TRULICITY 0.75 MG/0.5 ML PEN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00002143401","LABEL_NAME":"TRULICITY 1.5 MG/0.5 ML PEN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00002143601","LABEL_NAME":"EMGALITY 120 MG/ML PEN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00002144211","LABEL_NAME":"OMVOH 200 MG/2 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00002144501","LABEL_NAME":"TALTZ 80 MG/ML AUTOINJECTOR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00002144509","LABEL_NAME":"TALTZ 80 MG/ML AUTOINJ (3-PK)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00002144527","LABEL_NAME":"TALTZ 80 MG/ML AUTOINJ (2-PK)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00002145701","LABEL_NAME":"MOUNJARO 15 MG/0.5 ML PEN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00002146001","LABEL_NAME":"MOUNJARO 12.5 MG/0.5 ML PEN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00002147101","LABEL_NAME":"MOUNJARO 10 MG/0.5 ML PEN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00002148401","LABEL_NAME":"MOUNJARO 7.5 MG/0.5 ML PEN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00002149501","LABEL_NAME":"MOUNJARO 5 MG/0.5 ML PEN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00002150601","LABEL_NAME":"MOUNJARO 2.5 MG/0.5 ML PEN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00002171728","LABEL_NAME":"INLURIYO 200 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00002223601","LABEL_NAME":"TRULICITY 3 MG/0.5 ML PEN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00002237701","LABEL_NAME":"EMGALITY 120 MG/ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00002311501","LABEL_NAME":"EMGALITY 100 MG/ML SYR(1 OF 3)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00002311509","LABEL_NAME":"EMGALITY 300 MG (100 MG X3SYR)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00002311601","LABEL_NAME":"OMVOH 200 MG/2 ML PEN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00002318201","LABEL_NAME":"TRULICITY 4.5 MG/0.5 ML PEN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00002418230","LABEL_NAME":"OLUMIANT 2 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00002447930","LABEL_NAME":"OLUMIANT 4 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00002448354","LABEL_NAME":"VERZENIO 50 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00002473230","LABEL_NAME":"OLUMIANT 1 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00002481554","LABEL_NAME":"VERZENIO 100 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00002533754","LABEL_NAME":"VERZENIO 150 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00002534060","LABEL_NAME":"RETEVMO 40 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00002556260","LABEL_NAME":"RETEVMO 160 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00002608260","LABEL_NAME":"RETEVMO 80 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00002612060","LABEL_NAME":"RETEVMO 120 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00002621654","LABEL_NAME":"VERZENIO 200 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00002690230","LABEL_NAME":"JAYPIRCA 50 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00002702660","LABEL_NAME":"JAYPIRCA 100 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00002751001","LABEL_NAME":"HUMALOG 100 UNIT/ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00002751101","LABEL_NAME":"HUMALOG MIX 75-25 VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00002751601","LABEL_NAME":"HUMALOG 100 UNIT/ML CARTRIDGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00002771401","LABEL_NAME":"HUMALOG JR 100 UNIT/ML KWIKPEN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00002771711","LABEL_NAME":"OMVOH 300 MG DOSE - 2 PENS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00002772211","LABEL_NAME":"OMVOH 300 MG DOSE - 2 SYRINGES","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00002772401","LABEL_NAME":"TALTZ 80 MG/ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00002773701","LABEL_NAME":"INSULIN LISPRO 100 UNIT/ML VL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00002775201","LABEL_NAME":"INSULIN LISPRO JR 100 UNIT/ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00002801101","LABEL_NAME":"OMVOH 100 MG/ML PEN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00002801127","LABEL_NAME":"OMVOH 200 MG DOSE - 2 PENS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00002814701","LABEL_NAME":"HUMATROPE 6 MG CARTRIDGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00002814801","LABEL_NAME":"HUMATROPE 12 MG CARTRIDGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00002814901","LABEL_NAME":"HUMATROPE 24 MG CARTRIDGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00002821501","LABEL_NAME":"HUMULIN R 100 UNIT/ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00002822201","LABEL_NAME":"INSULIN LISPRO 100 UNIT/ML PEN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00002823301","LABEL_NAME":"INSULIN LISPRO MIX 75-25 KWKPN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00002831501","LABEL_NAME":"HUMULIN N 100 UNIT/ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00002871501","LABEL_NAME":"HUMULIN 70-30 VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00002879701","LABEL_NAME":"HUMALOG MIX 75-25 KWIKPEN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00002879801","LABEL_NAME":"HUMALOG MIX 50-50 KWIKPEN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00002879901","LABEL_NAME":"HUMALOG 100 UNIT/ML KWIKPEN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00002880301","LABEL_NAME":"HUMULIN 70/30 KWIKPEN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00002880501","LABEL_NAME":"HUMULIN N 100 UNIT/ML KWIKPEN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00002882401","LABEL_NAME":"HUMULIN R 500 UNIT/ML KWIKPEN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00002887001","LABEL_NAME":"OMVOH 100 MG/ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00002887027","LABEL_NAME":"OMVOH 200 MG DOSE - 2 SYRINGES","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00002890011","LABEL_NAME":"TALTZ 20 MG/0.25 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00002890511","LABEL_NAME":"TALTZ 40 MG/0.5 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00003089321","LABEL_NAME":"ELIQUIS 2.5 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00003089421","LABEL_NAME":"ELIQUIS 5 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00003089511","LABEL_NAME":"SOTYKTU 6 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00003161412","LABEL_NAME":"BARACLUDE 0.05 MG/ML SOLUTION","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00003218811","LABEL_NAME":"ORENCIA 125 MG/ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00003218851","LABEL_NAME":"ORENCIA CLICKJECT 125 MG/ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00003281411","LABEL_NAME":"ORENCIA 50 MG/0.4 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00003281811","LABEL_NAME":"ORENCIA 87.5 MG/0.7 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00003364111","LABEL_NAME":"EVOTAZ 300 MG-150 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00003376474","LABEL_NAME":"ELIQUIS DVT-PE TREAT START 5MG","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00003404012","LABEL_NAME":"AUGTYRO 40 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00003416014","LABEL_NAME":"AUGTYRO 160 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00004040509","LABEL_NAME":"MIRCERA 200 MCG/0.3 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00005010001","LABEL_NAME":"TRUMENBA 120 MCG/0.5 ML VACCIN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00005200002","LABEL_NAME":"PREVNAR 20 SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00006007861","LABEL_NAME":"JANUMET XR 50-500 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00006008061","LABEL_NAME":"JANUMET XR 50-1,000 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00006008131","LABEL_NAME":"JANUMET XR 100-1,000 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00006011228","LABEL_NAME":"JANUVIA 50 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00006022101","LABEL_NAME":"JANUVIA 25 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00006022761","LABEL_NAME":"ISENTRESS 400 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00006027701","LABEL_NAME":"JANUVIA 100 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00006047361","LABEL_NAME":"ISENTRESS 25 MG TABLET CHEW","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00006047761","LABEL_NAME":"ISENTRESS 100 MG TABLET CHEW","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00006056840","LABEL_NAME":"ZOLINZA 100 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00006057561","LABEL_NAME":"JANUMET 50-500 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00006057761","LABEL_NAME":"JANUMET 50-1,000 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00006307401","LABEL_NAME":"ZEPATIER 50-100 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00006307502","LABEL_NAME":"PREVYMIS 240 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00006307602","LABEL_NAME":"PREVYMIS 480 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00006308001","LABEL_NAME":"ISENTRESS HD 600 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00006409302","LABEL_NAME":"RECOMBIVAX HB 5 MCG/0.5 ML SYR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00006409401","LABEL_NAME":"RECOMBIVAX HB 10 MCG/ML SYR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00006409501","LABEL_NAME":"VAQTA 25 UNITS/0.5 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00006409601","LABEL_NAME":"VAQTA 50 UNITS/ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00006411901","LABEL_NAME":"GARDASIL 9 VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00006412101","LABEL_NAME":"GARDASIL 9 SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00006417100","LABEL_NAME":"PROQUAD VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00006432903","LABEL_NAME":"VAXNEUVANCE 0.5 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00006434702","LABEL_NAME":"CAPVAXIVE 0.5 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00006468100","LABEL_NAME":"M-M-R II VACCINE VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00006482700","LABEL_NAME":"VARIVAX VACCINE WITH DILUENT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00006482701","LABEL_NAME":"VARIVAX VACCINE VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00006483101","LABEL_NAME":"VAQTA 25 UNITS/0.5 ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00006483701","LABEL_NAME":"PNEUMOVAX 23 SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00006484100","LABEL_NAME":"VAQTA 50 UNITS/ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00006489700","LABEL_NAME":"PEDVAXHIB VACCINE VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00006498100","LABEL_NAME":"RECOMBIVAX HB 5 MCG/0.5 ML VL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00006499200","LABEL_NAME":"RECOMBIVAX HB 40 MCG/ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00006499501","LABEL_NAME":"RECOMBIVAX HB 10 MCG/ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00006502801","LABEL_NAME":"VERQUVO 2.5 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00006502901","LABEL_NAME":"VERQUVO 5 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00006503001","LABEL_NAME":"VERQUVO 10 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00006508501","LABEL_NAME":"PREVYMIS 120 MG PELLET PACKET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00006508601","LABEL_NAME":"PREVYMIS 20 MG PELLET PACKET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00006508701","LABEL_NAME":"WINREVAIR 45 MG TWO-VIAL KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00006508801","LABEL_NAME":"WINREVAIR 60 MG TWO-VIAL KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00006509001","LABEL_NAME":"WINREVAIR 45 MG ONE-VIAL KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00006509101","LABEL_NAME":"WINREVAIR 60 MG ONE-VIAL KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00006533101","LABEL_NAME":"WELIREG 40 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00009000501","LABEL_NAME":"SOLU-CORTEF 1,000 MG ACT-O-VL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00009001103","LABEL_NAME":"SOLU-CORTEF 100 MG ACT-O-VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00009001305","LABEL_NAME":"SOLU-CORTEF 250 MG ACT-O-VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00009082501","LABEL_NAME":"SOLU-CORTEF 100 MG VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00009517502","LABEL_NAME":"SOMAVERT 10 MG VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00009520104","LABEL_NAME":"SOMAVERT 25 MG VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00009537604","LABEL_NAME":"SOMAVERT 30 MG VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00009540101","LABEL_NAME":"NICOTROL NS 10 MG/ML SPRAY","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00009716830","LABEL_NAME":"SOMAVERT 15 MG VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00009718801","LABEL_NAME":"SOMAVERT 20 MG VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00009766705","LABEL_NAME":"CLEOCIN 100 MG VAGINAL OVULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00013262681","LABEL_NAME":"GENOTROPIN 5 MG CARTRIDGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00013264681","LABEL_NAME":"GENOTROPIN 12 MG CARTRIDGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00013264901","LABEL_NAME":"GENOTROPIN MINIQUICK 0.2 MG","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00013265002","LABEL_NAME":"GENOTROPIN MINIQUICK 0.4 MG","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00013265102","LABEL_NAME":"GENOTROPIN MINIQUICK 0.6 MG","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00013265202","LABEL_NAME":"GENOTROPIN MINIQUICK 0.8 MG","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00013265302","LABEL_NAME":"GENOTROPIN MINIQUICK 1 MG","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00013265402","LABEL_NAME":"GENOTROPIN MINIQUICK 1.2 MG","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00013265502","LABEL_NAME":"GENOTROPIN MINIQUICK 1.4 MG","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00013265602","LABEL_NAME":"GENOTROPIN MINIQUICK 1.6 MG","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00013265702","LABEL_NAME":"GENOTROPIN MINIQUICK 1.8 MG","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00013265802","LABEL_NAME":"GENOTROPIN MINIQUICK 2 MG","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00023114501","LABEL_NAME":"BOTOX 100 UNIT VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00023320503","LABEL_NAME":"LUMIGAN 0.01% EYE DROPS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00023392102","LABEL_NAME":"BOTOX 200 UNIT VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00023615004","LABEL_NAME":"CRINONE 4% GEL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00023615108","LABEL_NAME":"CRINONE 8% GEL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00023649802","LABEL_NAME":"UBRELVY 50 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00023650102","LABEL_NAME":"UBRELVY 100 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00024414260","LABEL_NAME":"MULTAQ 400 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00024576105","LABEL_NAME":"SOLIQUA 100 UNIT-33 MCG/ML PEN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00024586901","LABEL_NAME":"TOUJEO SOLOSTAR 300 UNIT/ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00024587100","LABEL_NAME":"TOUJEO MAX SOLOSTR 300 UNIT/ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00024591001","LABEL_NAME":"KEVZARA 200 MG/1.14 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00024591400","LABEL_NAME":"DUPIXENT 300 MG/2 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00024591500","LABEL_NAME":"DUPIXENT 300 MG/2 ML PEN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00024591801","LABEL_NAME":"DUPIXENT 200 MG/1.14 ML SYRING","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00024591900","LABEL_NAME":"DUPIXENT 200 MG/1.14 ML PEN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00024592001","LABEL_NAME":"KEVZARA 150 MG/1.14 ML PEN INJ","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00024592201","LABEL_NAME":"KEVZARA 200 MG/1.14 ML PEN INJ","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00025016608","LABEL_NAME":"SYNAREL 2 MG/ML NASAL SPRAY","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00032004570","LABEL_NAME":"CREON DR 3,000 UNIT CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00032004670","LABEL_NAME":"CREON DR 6,000 UNIT CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00032004770","LABEL_NAME":"CREON DR 12,000 UNIT CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00032122401","LABEL_NAME":"CREON DR 24,000 UNIT CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00032263701","LABEL_NAME":"CREON DR 36,000 UNIT CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00037682210","LABEL_NAME":"PROCTOFOAM-HC 1%-1% FOAM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00037686010","LABEL_NAME":"DIPENTUM 250 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00046087221","LABEL_NAME":"PREMARIN VAGINAL CREAM-APPL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00046110511","LABEL_NAME":"PREMPRO 0.3 MG-1.5 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00046110611","LABEL_NAME":"PREMPRO 0.45-1.5 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00046110711","LABEL_NAME":"PREMPRO 0.625-2.5 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00046110811","LABEL_NAME":"PREMPRO 0.625-5 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00046257512","LABEL_NAME":"PREMPHASE 0.625-5 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054000713","LABEL_NAME":"CALCITRIOL 0.25 MCG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054001020","LABEL_NAME":"FLECAINIDE ACETATE 50 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054001120","LABEL_NAME":"FLECAINIDE ACETATE 100 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054001221","LABEL_NAME":"FLECAINIDE ACETATE 150 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054001825","LABEL_NAME":"PREDNISONE 20 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054002025","LABEL_NAME":"LITHIUM CARBONATE ER 450 MG TB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054002125","LABEL_NAME":"LITHIUM CARBONATE ER 300 MG TB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054002511","LABEL_NAME":"MEFLOQUINE HCL 250 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054004544","LABEL_NAME":"IPRATROPIUM 0.03% SPRAY","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054004641","LABEL_NAME":"IPRATROPIUM 0.06% SPRAY","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054005746","LABEL_NAME":"DIGOXIN 0.05 MG/ML SOLUTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054006258","LABEL_NAME":"CITALOPRAM HBR 10 MG/5 ML SOLN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054006447","LABEL_NAME":"ONDANSETRON 4 MG/5 ML SOLUTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054007725","LABEL_NAME":"TORSEMIDE 20 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054007928","LABEL_NAME":"BALSALAZIDE DISODIUM 750 MG CP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054008013","LABEL_NAME":"EXEMESTANE 25 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054008425","LABEL_NAME":"ZALEPLON 5 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054008525","LABEL_NAME":"ZALEPLON 10 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054008813","LABEL_NAME":"CALCIUM ACETATE 667 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054014025","LABEL_NAME":"ACARBOSE 25 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054014125","LABEL_NAME":"ACARBOSE 50 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054014225","LABEL_NAME":"ACARBOSE 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054016325","LABEL_NAME":"MYCOPHENOLATE 250 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054016625","LABEL_NAME":"MYCOPHENOLATE 500 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054017613","LABEL_NAME":"BUPRENORPHINE 2 MG TABLET SL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054017713","LABEL_NAME":"BUPRENORPHINE 8 MG TABLET SL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054018813","LABEL_NAME":"BUPRENORPHINE-NALOX 2-0.5MG TB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054018913","LABEL_NAME":"BUPRENORPHINE-NALOX 8-2 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054021025","LABEL_NAME":"PROTRIPTYLINE HCL 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054021125","LABEL_NAME":"PROTRIPTYLINE HCL 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054023524","LABEL_NAME":"MORPHINE SULFATE IR 15 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054023624","LABEL_NAME":"MORPHINE SULFATE IR 30 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054023749","LABEL_NAME":"MORPHINE SULF 10 MG/5 ML SOLN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054023849","LABEL_NAME":"MORPHINE SULF 20 MG/5 ML SOLN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054024324","LABEL_NAME":"CODEINE SULFATE 15 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054024424","LABEL_NAME":"CODEINE SULFATE 30 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054024525","LABEL_NAME":"CODEINE SULFATE 60 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054027803","LABEL_NAME":"NARATRIPTAN HCL 1 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054027903","LABEL_NAME":"NARATRIPTAN HCL 2.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054028325","LABEL_NAME":"OXYMORPHONE HCL 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054028425","LABEL_NAME":"OXYMORPHONE HCL 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054029513","LABEL_NAME":"ALOSETRON HCL 0.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054031950","LABEL_NAME":"LINEZOLID 100 MG/5 ML SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054032656","LABEL_NAME":"FLUTICASONE-SALMETEROL 100-50","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054032756","LABEL_NAME":"FLUTICASONE-SALMETEROL 250-50","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054032856","LABEL_NAME":"FLUTICASONE-SALMETEROL 500-50","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054033425","LABEL_NAME":"CEVIMELINE HCL 30 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054035625","LABEL_NAME":"DISULFIRAM 250 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054037025","LABEL_NAME":"LISDEXAMFETAMINE 20 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054037125","LABEL_NAME":"LISDEXAMFETAMINE 30 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054037225","LABEL_NAME":"LISDEXAMFETAMINE 40 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054037325","LABEL_NAME":"LISDEXAMFETAMINE 50 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054037425","LABEL_NAME":"LISDEXAMFETAMINE 60 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054037525","LABEL_NAME":"LISDEXAMFETAMINE 70 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054038225","LABEL_NAME":"CYCLOPHOSPHAMIDE 25 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054038325","LABEL_NAME":"CYCLOPHOSPHAMIDE 50 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054038663","LABEL_NAME":"HYDROMORPHONE 1 MG/ML SOLUTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054039041","LABEL_NAME":"OXYCODONE HCL 5 MG/5 ML SOLN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054039168","LABEL_NAME":"METHADONE 10 MG/ML ORAL CONC","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054039925","LABEL_NAME":"BEXAROTENE 75 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054040013","LABEL_NAME":"DESVENLAFAXINE SUCCNT ER 50 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054040113","LABEL_NAME":"DESVENLAFAXINE SUCCNT ER 100MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054040713","LABEL_NAME":"RITONAVIR 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054041313","LABEL_NAME":"FEBUXOSTAT 40 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054041413","LABEL_NAME":"FEBUXOSTAT 80 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054042523","LABEL_NAME":"RUFINAMIDE 200 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054042623","LABEL_NAME":"RUFINAMIDE 400 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054044949","LABEL_NAME":"POSACONAZOLE 200 MG/5 ML SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054048013","LABEL_NAME":"EVEROLIMUS 2.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054048113","LABEL_NAME":"EVEROLIMUS 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054048213","LABEL_NAME":"EVEROLIMUS 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054049713","LABEL_NAME":"EVEROLIMUS 7.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054050823","LABEL_NAME":"ICOSAPENT ETHYL 1 GRAM CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054051741","LABEL_NAME":"MORPHINE SULF 100 MG/5 ML CONC","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054052863","LABEL_NAME":"RUFINAMIDE 40 MG/ML SUSPENSION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054057625","LABEL_NAME":"DEFERIPRONE 500 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054060313","LABEL_NAME":"DESVENLAFAXINE SUCCNT ER 25 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054062127","LABEL_NAME":"ICOSAPENT ETHYL 0.5 GM CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054062263","LABEL_NAME":"DICYCLOMINE 10 MG/5 ML SOLN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054063905","LABEL_NAME":"METHYLERGONOVINE 0.2 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054065225","LABEL_NAME":"VIGABATRIN 500 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054066025","LABEL_NAME":"LISDEXAMFETAMINE 10 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054066882","LABEL_NAME":"ALVIMOPAN 12 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054070920","LABEL_NAME":"METHADONE HCL 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054071020","LABEL_NAME":"METHADONE HCL 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054071119","LABEL_NAME":"DEFERIPRONE 1,000 MG TB(3X/DY)","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054074825","LABEL_NAME":"DICYCLOMINE 10 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054074913","LABEL_NAME":"PRUCALOPRIDE 1 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054075013","LABEL_NAME":"PRUCALOPRIDE 2 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054081221","LABEL_NAME":"PYRAZINAMIDE 500 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054084363","LABEL_NAME":"HYDROCODONE-ACETAMIN 10-300/15","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054090623","LABEL_NAME":"SAPROPTERIN 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054110058","LABEL_NAME":"AMINOCAPROIC ACID 0.25 GRAM/ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054111013","LABEL_NAME":"AMINOCAPROIC ACID 1,000 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054252625","LABEL_NAME":"LITHIUM CARBONATE 150 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054252725","LABEL_NAME":"LITHIUM CARBONATE 300 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054253125","LABEL_NAME":"LITHIUM CARBONATE 600 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054300001","LABEL_NAME":"BUTALB-ACETAMIN-CAF-COD 50-325","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054309036","LABEL_NAME":"BUTORPHANOL 10 MG/ML SPRAY","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054312041","LABEL_NAME":"CALCITRIOL 1 MCG/ML SOLUTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054317757","LABEL_NAME":"DEXAMETHASONE 0.5 MG/5 ML LIQ","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054318544","LABEL_NAME":"DIAZEPAM 5 MG/ML ORAL CONC","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054318863","LABEL_NAME":"DIAZEPAM 5 MG/5 ML SOLUTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054327099","LABEL_NAME":"FLUTICASONE PROP 50 MCG SPRAY","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054329446","LABEL_NAME":"FUROSEMIDE 10 MG/ML SOLUTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054329863","LABEL_NAME":"FUROSEMIDE 40 MG/5 ML SOLN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054350049","LABEL_NAME":"LIDOCAINE 2% VISCOUS SOLN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054350547","LABEL_NAME":"LIDOCAINE HCL 4% SOLUTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054353244","LABEL_NAME":"LORAZEPAM INTENSOL 2 MG/ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054354563","LABEL_NAME":"MEPERIDINE 50 MG/5 ML SOLUTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054355344","LABEL_NAME":"METHADONE INTENSOL 10 MG/ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054355563","LABEL_NAME":"METHADONE 5 MG/5 ML SOLUTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054355663","LABEL_NAME":"METHADONE 10 MG/5 ML SOLUTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054356699","LABEL_NAME":"MIDAZOLAM HCL 2 MG/ML SYRUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054372250","LABEL_NAME":"PREDNISONE 5 MG/5 ML SOLUTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054372763","LABEL_NAME":"PROPRANOLOL 20 MG/5 ML SOLN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054373063","LABEL_NAME":"PROPRANOLOL 40 MG/5 ML SOLN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054414622","LABEL_NAME":"CLOTRIMAZOLE 10 MG TROCHE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054417925","LABEL_NAME":"DEXAMETHASONE 0.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054418025","LABEL_NAME":"DEXAMETHASONE 0.75 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054418125","LABEL_NAME":"DEXAMETHASONE 1 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054418225","LABEL_NAME":"DEXAMETHASONE 1.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054418325","LABEL_NAME":"DEXAMETHASONE 2 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054418425","LABEL_NAME":"DEXAMETHASONE 4 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054418625","LABEL_NAME":"DEXAMETHASONE 6 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054429725","LABEL_NAME":"FUROSEMIDE 20 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054429925","LABEL_NAME":"FUROSEMIDE 40 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054430125","LABEL_NAME":"FUROSEMIDE 80 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054449613","LABEL_NAME":"LEUCOVORIN CALCIUM 5 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054449705","LABEL_NAME":"LEUCOVORIN CALCIUM 10 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054449810","LABEL_NAME":"LEUCOVORIN CALCIUM 15 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054449911","LABEL_NAME":"LEUCOVORIN CALCIUM 25 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054452725","LABEL_NAME":"LITHIUM CARBONATE 300 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054455025","LABEL_NAME":"METHOTREXATE 2.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054458111","LABEL_NAME":"MERCAPTOPURINE 50 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054485825","LABEL_NAME":"TRIAZOLAM 0.125 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054485925","LABEL_NAME":"TRIAZOLAM 0.25 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054962857","LABEL_NAME":"SODIUM OXYBATE 0.5 G/ML SOLN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054981725","LABEL_NAME":"PREDNISONE 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00054982825","LABEL_NAME":"PREDNISONE 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00065034302","LABEL_NAME":"PHENYLEPHRINE 10% EYE DROP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00065034904","LABEL_NAME":"PHENYLEPHRINE 2.5% EYE DROP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00065041130","LABEL_NAME":"BETADINE 5% EYE SOLUTION","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00065074114","LABEL_NAME":"TETRACAINE 0.5% STERI-UNIT SOL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00065081701","LABEL_NAME":"ATROPINE 1% EYE DROPS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00067067430","LABEL_NAME":"LORATADINE 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00067489014","LABEL_NAME":"NICOTINE 14 MG/24HR PATCH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00067490014","LABEL_NAME":"NICOTINE 21 MG/24HR PATCH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00067611730","LABEL_NAME":"ALLERGY RELIEF 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00069004301","LABEL_NAME":"HEPARIN 2,000 UNIT/2 ML VIAL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069013501","LABEL_NAME":"BOSULIF 100 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069013601","LABEL_NAME":"BOSULIF 500 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069014501","LABEL_NAME":"INLYTA 1 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069015111","LABEL_NAME":"INLYTA 5 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069018721","LABEL_NAME":"IBRANCE 75 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069018821","LABEL_NAME":"IBRANCE 100 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069018921","LABEL_NAME":"IBRANCE 125 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069019301","LABEL_NAME":"BOSULIF 400 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069019501","LABEL_NAME":"FRAGMIN 2,500 UNIT/0.2 ML SYR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069019601","LABEL_NAME":"FRAGMIN 5,000 UNIT/0.2 ML SYR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069019730","LABEL_NAME":"VIZIMPRO 15 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069020601","LABEL_NAME":"FRAGMIN 7,500 UNIT/0.3 ML SYR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069021701","LABEL_NAME":"FRAGMIN 10,000 UNIT/ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069022001","LABEL_NAME":"FRAGMIN 12,500 UNIT/0.5 ML SYR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069022301","LABEL_NAME":"FRAGMIN 15,000 UNIT/0.6 ML SYR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069022701","LABEL_NAME":"LORBRENA 25 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069022801","LABEL_NAME":"FRAGMIN 18,000 UNIT/0.72 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069023101","LABEL_NAME":"LORBRENA 100 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069023201","LABEL_NAME":"FRAGMIN 95,000 UNIT/3.8 ML VL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069025160","LABEL_NAME":"XALKORI 20 MG PELLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069025230","LABEL_NAME":"TALZENNA 0.1 MG SOFTGEL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069025301","LABEL_NAME":"FRAGMIN 10,000 UNIT/4 ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069027430","LABEL_NAME":"VELSIPITY 2 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069028403","LABEL_NAME":"IBRANCE 75 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069029101","LABEL_NAME":"NIVESTYM 300 MCG/0.5 ML SYRING","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069029201","LABEL_NAME":"NIVESTYM 480 MCG/0.8 ML SYRING","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069029301","LABEL_NAME":"NIVESTYM 300 MCG/ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069029401","LABEL_NAME":"NIVESTYM 480 MCG/1.6 ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069029860","LABEL_NAME":"DAURISMO 25 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069032401","LABEL_NAME":"NYVEPRIA 6 MG/0.6 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069033428","LABEL_NAME":"LITFULO 50 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069035330","LABEL_NAME":"TALZENNA 0.25 MG SOFTGEL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069045430","LABEL_NAME":"TALZENNA 0.35 MG SOFTGEL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069048603","LABEL_NAME":"IBRANCE 100 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069050130","LABEL_NAME":"XELJANZ XR 11 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069050230","LABEL_NAME":"XELJANZ XR 22 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069050430","LABEL_NAME":"BOSULIF 50 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069050501","LABEL_NAME":"NGENLA PEN 24 MG/1.2 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069050760","LABEL_NAME":"XALKORI 50 MG PELLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069052001","LABEL_NAME":"NGENLA PEN 60 MG/1.2 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069054630","LABEL_NAME":"TALZENNA 0.5 MG SOFTGEL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069060001","LABEL_NAME":"PENBRAYA KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069065530","LABEL_NAME":"TALZENNA 0.75 MG SOFTGEL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069068803","LABEL_NAME":"IBRANCE 125 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069075730","LABEL_NAME":"TALZENNA 1 MG SOFTGEL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069100101","LABEL_NAME":"XELJANZ 5 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069100201","LABEL_NAME":"XELJANZ 10 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069101415","LABEL_NAME":"BOSULIF 100 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069102901","LABEL_NAME":"XELJANZ 1 MG/ML SOLUTION","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069119830","LABEL_NAME":"VIZIMPRO 30 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069130501","LABEL_NAME":"RETACRIT 2,000 UNIT/ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069130601","LABEL_NAME":"RETACRIT 3,000 UNIT/ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069130701","LABEL_NAME":"RETACRIT 4,000 UNIT/ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069130801","LABEL_NAME":"RETACRIT 10,000 UNIT/ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069130901","LABEL_NAME":"RETACRIT 40,000 UNIT/ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069131101","LABEL_NAME":"RETACRIT 20,000 UNIT/ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069131801","LABEL_NAME":"RETACRIT 20,000 UNIT/2 ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069150060","LABEL_NAME":"XALKORI 150 MG PELLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069153130","LABEL_NAME":"DAURISMO 100 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069197512","LABEL_NAME":"VYNDAQEL 20 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069215101","LABEL_NAME":"HYMPAVZI 150 MG/ML PEN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069229930","LABEL_NAME":"VIZIMPRO 45 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069246501","LABEL_NAME":"ABRYSVO ACT-O-VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069250101","LABEL_NAME":"COMIRNATY 2025-26(5-11Y) VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069252801","LABEL_NAME":"COMIRNATY 2025-26(12Y UP) SYRG","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069350001","LABEL_NAME":"ZAVZPRET 10 MG NASAL SPRAY","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069504506","LABEL_NAME":"PAXLOVID 300-100 MG DOSE PACK","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069543402","LABEL_NAME":"PAXLOVID 150-100 MG (MODERATE)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069545011","LABEL_NAME":"PAXLOVID 300/150-100MG(SEVERE)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069588624","LABEL_NAME":"LEDERLE LEUCOVORIN 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069814020","LABEL_NAME":"XALKORI 250 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069814120","LABEL_NAME":"XALKORI 200 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00069873001","LABEL_NAME":"VYNDAMAX 61 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00074003828","LABEL_NAME":"ORILISSA 150 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00074003956","LABEL_NAME":"ORILISSA 200 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00074050101","LABEL_NAME":"VYALEV 120 MG-2,400 MG/10ML VL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00074056111","LABEL_NAME":"VENCLEXTA 10 MG TAB (10MG X 2)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00074056114","LABEL_NAME":"VENCLEXTA 10 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00074056607","LABEL_NAME":"VENCLEXTA 50 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00074057611","LABEL_NAME":"VENCLEXTA 100 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00074057928","LABEL_NAME":"VENCLEXTA STARTING PACK","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00074101756","LABEL_NAME":"ORIAHNN 300-1-0.5MG/300MG CAPS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00074104328","LABEL_NAME":"RINVOQ ER 45 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00074105001","LABEL_NAME":"SKYRIZI 150 MG/ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00074106501","LABEL_NAME":"SKYRIZI 180 MG/1.2 ML ON-BODY","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00074106901","LABEL_NAME":"SKYRIZI 360 MG/2.4 ML ON-BODY","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00074210001","LABEL_NAME":"SKYRIZI 150 MG/ML PEN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00074210803","LABEL_NAME":"LUPRON DEPOT-PED 7.5 MG KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00074228203","LABEL_NAME":"LUPRON DEPOT-PED 11.25 MG KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00074230630","LABEL_NAME":"RINVOQ ER 15 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00074231030","LABEL_NAME":"RINVOQ ER 30 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00074232001","LABEL_NAME":"RINVOQ LQ 1 MG/ML SOLUTION","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00074244003","LABEL_NAME":"LUPRON DEPOT-PED 15 MG KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00074260028","LABEL_NAME":"MAVYRET 50-20 MG PELLET PACKET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00074262504","LABEL_NAME":"MAVYRET 100-40 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00074301207","LABEL_NAME":"DUOPA 4.63 MG-20 MG/ML SUSPENS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00074310832","LABEL_NAME":"GENGRAF 25 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00074310932","LABEL_NAME":"GENGRAF 100 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00074334603","LABEL_NAME":"LUPRON DEPOT 22.5 MG 3MO KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00074347303","LABEL_NAME":"LUPRON DEPOT 45 MG 6MO KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00074357501","LABEL_NAME":"LUPRON DEPOT-PED 45 MG 6MO KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00074364103","LABEL_NAME":"LUPRON DEPOT 3.75 MG KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00074364203","LABEL_NAME":"LUPRON DEPOT 7.5 MG KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00074366303","LABEL_NAME":"LUPRON DEPOT 11.25 MG 3MO KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00074368303","LABEL_NAME":"LUPRON DEPOT-4 MONTH KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00074372719","LABEL_NAME":"SYNTHROID 137 MCG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00074377903","LABEL_NAME":"LUPRON DEPOT-PED 11.25 MG 3MO","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00074395646","LABEL_NAME":"KALETRA 80 MG-20 MG/ML SOLN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00074434119","LABEL_NAME":"SYNTHROID 25 MCG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00074455211","LABEL_NAME":"SYNTHROID 50 MCG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00074518211","LABEL_NAME":"SYNTHROID 75 MCG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00074659419","LABEL_NAME":"SYNTHROID 88 MCG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00074662411","LABEL_NAME":"SYNTHROID 100 MCG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00074706811","LABEL_NAME":"SYNTHROID 125 MCG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00074706911","LABEL_NAME":"SYNTHROID 150 MCG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00074707019","LABEL_NAME":"SYNTHROID 175 MCG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00074709430","LABEL_NAME":"QULIPTA 60 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00074709530","LABEL_NAME":"QULIPTA 10 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00074709630","LABEL_NAME":"QULIPTA 30 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00074714811","LABEL_NAME":"SYNTHROID 200 MCG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00074714919","LABEL_NAME":"SYNTHROID 300 MCG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00074726950","LABEL_NAME":"GENGRAF 100 MG/ML SOLUTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00074929619","LABEL_NAME":"SYNTHROID 112 MCG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00074969403","LABEL_NAME":"LUPRON DEPOT-PED 30 MG 3MO KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00078056845","LABEL_NAME":"COARTEM TABLETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00078063019","LABEL_NAME":"TOBI PODHALER 28 MG INHALE CAP","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00078063941","LABEL_NAME":"COSENTYX SNRDY 300MG DOSE-2PEN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00078063968","LABEL_NAME":"COSENTYX SENSOREADY 150 MG PEN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00078063997","LABEL_NAME":"COSENTYX 150 MG/ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00078063998","LABEL_NAME":"COSENTYX 300 MG DOSE-2 SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00078064515","LABEL_NAME":"ODOMZO 200 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00078068166","LABEL_NAME":"TAFINLAR 75 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00078068266","LABEL_NAME":"TAFINLAR 50 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00078069484","LABEL_NAME":"ZYKADIA 150 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00078069802","LABEL_NAME":"RYDAPT 25 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00078070151","LABEL_NAME":"PIQRAY 200 MG DAILY DOSE PACK","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00078070802","LABEL_NAME":"PIQRAY 300 MG DAILY DOSE PACK","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00078070956","LABEL_NAME":"TABRECTA 150 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00078071502","LABEL_NAME":"PIQRAY 250 MG DAILY DOSE PACK","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00078071656","LABEL_NAME":"TABRECTA 200 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00078086001","LABEL_NAME":"KISQALI 200 MG DAILY DOSE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00078086714","LABEL_NAME":"KISQALI 400 MG DAILY DOSE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00078087421","LABEL_NAME":"KISQALI 600 MG DAILY DOSE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00078100768","LABEL_NAME":"KESIMPTA 20 MG/0.4 ML PEN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00078102151","LABEL_NAME":"VIJOICE 50 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00078102884","LABEL_NAME":"VIJOICE 125 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00078103502","LABEL_NAME":"VIJOICE 250 MG DAILY DOSE PACK","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00078105697","LABEL_NAME":"COSENTYX 75 MG/0.5 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00078107068","LABEL_NAME":"COSENTYX UNOREADY 300 MG PEN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00078109120","LABEL_NAME":"SCEMBLIX 20 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00078109820","LABEL_NAME":"SCEMBLIX 40 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00078110515","LABEL_NAME":"MEKINIST 0.5 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00078111215","LABEL_NAME":"MEKINIST 2 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00078115421","LABEL_NAME":"TAFINLAR 10 MG TABLET FOR SUSP","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00078116147","LABEL_NAME":"MEKINIST 0.05 MG/ML SOLUTION","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00078117519","LABEL_NAME":"VIJOICE 50 MG GRANULE PACKET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00078118920","LABEL_NAME":"FABHALTA 200 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00078119620","LABEL_NAME":"SCEMBLIX 100 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00078142015","LABEL_NAME":"VANRAFIA 0.75 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00078148320","LABEL_NAME":"RHAPSIDO 25 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00085222401","LABEL_NAME":"NOXAFIL 300 MG POWDERMIX SUSP","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00087040501","LABEL_NAME":"POLY-VI-SOL WITH IRON DROPS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00087086644","LABEL_NAME":"D-VI-SOL 10 MCG/ML DROP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00088210201","LABEL_NAME":"PRIFTIN 150 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00088221901","LABEL_NAME":"LANTUS SOLOSTAR 100 UNIT/ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00088222033","LABEL_NAME":"LANTUS 100 UNIT/ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093001006","LABEL_NAME":"TOLTERODINE TARTRATE 1 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093001701","LABEL_NAME":"MOEXIPRIL HCL 7.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093001805","LABEL_NAME":"TOLTERODINE TARTRATE 2 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093005101","LABEL_NAME":"CARVEDILOL 3.125 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093005301","LABEL_NAME":"BUSPIRONE HCL 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093005401","LABEL_NAME":"BUSPIRONE HCL 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093013501","LABEL_NAME":"CARVEDILOL 6.25 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093026215","LABEL_NAME":"FLUOCINONIDE 0.05% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093026415","LABEL_NAME":"FLUOCINONIDE 0.05% OINTMENT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093031401","LABEL_NAME":"KETOROLAC 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093031801","LABEL_NAME":"DILTIAZEM 30 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093031901","LABEL_NAME":"DILTIAZEM 60 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093032001","LABEL_NAME":"DILTIAZEM 90 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093032101","LABEL_NAME":"DILTIAZEM 120 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093057606","LABEL_NAME":"LOVASTATIN 20 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093075201","LABEL_NAME":"ATENOLOL 50 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093075301","LABEL_NAME":"ATENOLOL 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093075601","LABEL_NAME":"PIROXICAM 10 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093075701","LABEL_NAME":"PIROXICAM 20 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093078701","LABEL_NAME":"ATENOLOL 25 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093081001","LABEL_NAME":"NORTRIPTYLINE HCL 10 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093081101","LABEL_NAME":"NORTRIPTYLINE HCL 25 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093081201","LABEL_NAME":"NORTRIPTYLINE HCL 50 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093081301","LABEL_NAME":"NORTRIPTYLINE HCL 75 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093083201","LABEL_NAME":"CLONAZEPAM 0.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093092606","LABEL_NAME":"LOVASTATIN 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093092806","LABEL_NAME":"LOVASTATIN 40 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093094801","LABEL_NAME":"DICLOFENAC POT 50 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093098301","LABEL_NAME":"NYSTATIN 500,000 UNIT ORAL TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093100301","LABEL_NAME":"BUSPIRONE HCL 15 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093101042","LABEL_NAME":"MUPIROCIN 2% OINTMENT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093102406","LABEL_NAME":"NEFAZODONE HCL 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093102506","LABEL_NAME":"NEFAZODONE HCL 200 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093102606","LABEL_NAME":"NEFAZODONE HCL 250 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093106001","LABEL_NAME":"SOTALOL 120 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093106101","LABEL_NAME":"SOTALOL 80 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093106201","LABEL_NAME":"SOTALOL 160 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093106301","LABEL_NAME":"SOTALOL 240 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093107701","LABEL_NAME":"CEFPROZIL 250 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093107853","LABEL_NAME":"CEFPROZIL 500 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093108701","LABEL_NAME":"CEFACLOR ER 500 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093110616","LABEL_NAME":"TERIPARATIDE 560MCG/2.24ML PEN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093111801","LABEL_NAME":"ETODOLAC ER 600 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093112201","LABEL_NAME":"ETODOLAC ER 400 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093113556","LABEL_NAME":"ACITRETIN 10 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093113656","LABEL_NAME":"ACITRETIN 25 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093113856","LABEL_NAME":"ACITRETIN 17.5 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093117201","LABEL_NAME":"PENICILLIN VK 250 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093117401","LABEL_NAME":"PENICILLIN VK 500 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093117701","LABEL_NAME":"NEOMYCIN 500 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093171201","LABEL_NAME":"WARFARIN SODIUM 1 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093171301","LABEL_NAME":"WARFARIN SODIUM 2 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093171401","LABEL_NAME":"WARFARIN SODIUM 2.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093171501","LABEL_NAME":"WARFARIN SODIUM 3 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093171601","LABEL_NAME":"WARFARIN SODIUM 4 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093171801","LABEL_NAME":"WARFARIN SODIUM 6 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093172001","LABEL_NAME":"WARFARIN SODIUM 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093172101","LABEL_NAME":"WARFARIN SODIUM 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093172301","LABEL_NAME":"WARFARIN SODIUM 7.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093202623","LABEL_NAME":"AZITHROMYCIN 200 MG/5 ML SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093202723","LABEL_NAME":"AZITHROMYCIN 100 MG/5 ML SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093206301","LABEL_NAME":"QUETIAPINE FUMARATE 25 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093206406","LABEL_NAME":"CILOSTAZOL 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093206506","LABEL_NAME":"CILOSTAZOL 50 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093206701","LABEL_NAME":"DOXAZOSIN MESYLATE 8 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093206801","LABEL_NAME":"DOXAZOSIN MESYLATE 4 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093206901","LABEL_NAME":"DOXAZOSIN MESYLATE 2 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093207001","LABEL_NAME":"DOXAZOSIN MESYLATE 1 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093214028","LABEL_NAME":"TRI-LO-SPRINTEC TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093217801","LABEL_NAME":"LIOTHYRONINE SOD 25 MCG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093217901","LABEL_NAME":"LIOTHYRONINE SOD 5 MCG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093218001","LABEL_NAME":"LIOTHYRONINE SOD 50 MCG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093220301","LABEL_NAME":"METOCLOPRAMIDE 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093220401","LABEL_NAME":"METOCLOPRAMIDE 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093221001","LABEL_NAME":"SUCRALFATE 1 GM TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093226301","LABEL_NAME":"AMOXICILLIN 500 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093226401","LABEL_NAME":"AMOXICILLIN 875 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093226701","LABEL_NAME":"AMOXICILLIN 125 MG TAB CHEW","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093226801","LABEL_NAME":"AMOXICILLIN 250 MG TAB CHEW","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093227034","LABEL_NAME":"AMOX-CLAV 200-28.5 MG TAB CHEW","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093227234","LABEL_NAME":"AMOX-CLAV 400-57 MG TAB CHEW","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093227434","LABEL_NAME":"AMOX-CLAV 500-125 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093227534","LABEL_NAME":"AMOX-CLAV 875-125 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093227773","LABEL_NAME":"AMOX-CLAV 200-28.5 MG/5 ML SUS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093227973","LABEL_NAME":"AMOX-CLAV 400-57 MG/5 ML SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093240101","LABEL_NAME":"HYDROXYCHLOROQUINE 200 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093300256","LABEL_NAME":"QUININE SULFATE 324 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093300819","LABEL_NAME":"LANSOPRAZOLE DR 15 MG ODT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093300919","LABEL_NAME":"LANSOPRAZOLE DR 30 MG ODT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093306056","LABEL_NAME":"RASAGILINE MESYLATE 0.5 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093306156","LABEL_NAME":"RASAGILINE MESYLATE 1 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093306619","LABEL_NAME":"ICATIBANT 30 MG/3 ML SYRINGE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093309819","LABEL_NAME":"RISEDRONATE SODIUM 35 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093309956","LABEL_NAME":"RISEDRONATE SODIUM 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093310056","LABEL_NAME":"RISEDRONATE SODIUM 30 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093310701","LABEL_NAME":"AMOXICILLIN 250 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093310905","LABEL_NAME":"AMOXICILLIN 500 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093312228","LABEL_NAME":"JINTELI 1 MG-5 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093312301","LABEL_NAME":"DICLOXACILLIN 250 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093312501","LABEL_NAME":"DICLOXACILLIN 500 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093312701","LABEL_NAME":"DISOPYRAMIDE 100 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093312901","LABEL_NAME":"DISOPYRAMIDE 150 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093313482","LABEL_NAME":"CAMRESE 0.15-0.03-0.01 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093314501","LABEL_NAME":"CEPHALEXIN 250 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093314701","LABEL_NAME":"CEPHALEXIN 500 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093316006","LABEL_NAME":"CEFDINIR 300 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093319601","LABEL_NAME":"CEFADROXIL 500 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093321201","LABEL_NAME":"CLONAZEPAM 1 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093321301","LABEL_NAME":"CLONAZEPAM 2 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093321915","LABEL_NAME":"KETOCONAZOLE 2% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093322308","LABEL_NAME":"ESTRADIOL 10 MCG VAGINAL INSRT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093323401","LABEL_NAME":"SULFASALAZINE 500 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093323921","LABEL_NAME":"BUPRENORPHINE 7.5 MCG/HR PATCH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093324101","LABEL_NAME":"BISOPROLOL-HCTZ 2.5-6.25 MG TB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093324201","LABEL_NAME":"BISOPROLOL-HCTZ 5-6.25 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093324356","LABEL_NAME":"BISOPROLOL-HCTZ 10-6.25 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093330101","LABEL_NAME":"TRAMADOL HCL 50 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093330416","LABEL_NAME":"RECLIPSEN 28 DAY TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093342001","LABEL_NAME":"CYCLOBENZAPRINE 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093342201","LABEL_NAME":"CYCLOBENZAPRINE 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093342501","LABEL_NAME":"LORAZEPAM 0.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093342601","LABEL_NAME":"LORAZEPAM 1 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093342701","LABEL_NAME":"LORAZEPAM 2 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093354143","LABEL_NAME":"ESTRADIOL 0.01% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093354256","LABEL_NAME":"ATOMOXETINE HCL 10 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093354356","LABEL_NAME":"ATOMOXETINE HCL 18 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093354456","LABEL_NAME":"ATOMOXETINE HCL 25 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093354556","LABEL_NAME":"ATOMOXETINE HCL 40 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093354656","LABEL_NAME":"ATOMOXETINE HCL 60 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093354756","LABEL_NAME":"ATOMOXETINE HCL 80 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093354856","LABEL_NAME":"ATOMOXETINE HCL 100 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093365621","LABEL_NAME":"BUPRENORPHINE 5 MCG/HR PATCH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093365721","LABEL_NAME":"BUPRENORPHINE 10 MCG/HR PATCH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093365821","LABEL_NAME":"BUPRENORPHINE 15 MCG/HR PATCH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093365921","LABEL_NAME":"BUPRENORPHINE 20 MCG/HR PATCH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093405953","LABEL_NAME":"CEFADROXIL 1 GM TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093406701","LABEL_NAME":"PRAZOSIN 1 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093406801","LABEL_NAME":"PRAZOSIN 2 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093406901","LABEL_NAME":"PRAZOSIN 5 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093408563","LABEL_NAME":"TOBRAMYCIN 300 MG/5 ML AMPULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093412573","LABEL_NAME":"PENICILLIN VK 125 MG/5 ML SOLN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093412773","LABEL_NAME":"PENICILLIN VK 250 MG/5 ML SOLN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093413664","LABEL_NAME":"CEFDINIR 125 MG/5 ML SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093413764","LABEL_NAME":"CEFDINIR 250 MG/5 ML SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093414545","LABEL_NAME":"LEVALBUTEROL 0.31 MG/3 ML SOL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093414645","LABEL_NAME":"LEVALBUTEROL 0.63 MG/3 ML SOL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093414845","LABEL_NAME":"LEVALBUTEROL 1.25 MG/3 ML SOL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093415573","LABEL_NAME":"AMOXICILLIN 250 MG/5 ML SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093416073","LABEL_NAME":"AMOXICILLIN 200 MG/5 ML SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093416173","LABEL_NAME":"AMOXICILLIN 400 MG/5 ML SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093417573","LABEL_NAME":"CEPHALEXIN 125 MG/5 ML SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093417773","LABEL_NAME":"CEPHALEXIN 250 MG/5 ML SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093503056","LABEL_NAME":"TIAGABINE HCL 2 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093503156","LABEL_NAME":"TIAGABINE HCL 4 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093504501","LABEL_NAME":"DEXMETHYLPHENIDATE ER 25 MG CP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093504601","LABEL_NAME":"DEXMETHYLPHENIDATE ER 35 MG CP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093505610","LABEL_NAME":"ATORVASTATIN 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093505705","LABEL_NAME":"ATORVASTATIN 80 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093505810","LABEL_NAME":"ATORVASTATIN 40 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093505910","LABEL_NAME":"ATORVASTATIN 20 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093506001","LABEL_NAME":"HYDROXYZINE HCL 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093506101","LABEL_NAME":"HYDROXYZINE HCL 25 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093506201","LABEL_NAME":"HYDROXYZINE HCL 50 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093515001","LABEL_NAME":"MOEXIPRIL HCL 15 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093520005","LABEL_NAME":"BUSPIRONE HCL 30 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093523456","LABEL_NAME":"EFAVIR-EMTRI-TENOF 600-200-300","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093526018","LABEL_NAME":"ALMOTRIPTAN MALATE 6.25 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093526119","LABEL_NAME":"ALMOTRIPTAN MALATE 12.5 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093532828","LABEL_NAME":"JUNEL FE 24 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093534601","LABEL_NAME":"METHYLPHENIDATE ER(LA) 20MG CP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093534701","LABEL_NAME":"METHYLPHENIDATE ER(LA) 30MG CP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093534801","LABEL_NAME":"METHYLPHENIDATE ER(LA) 40MG CP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093542088","LABEL_NAME":"CABERGOLINE 0.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093545528","LABEL_NAME":"MIMVEY 1-0.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093552606","LABEL_NAME":"ATAZANAVIR SULFATE 150 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093552706","LABEL_NAME":"ATAZANAVIR SULFATE 200 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093552856","LABEL_NAME":"ATAZANAVIR SULFATE 300 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093555001","LABEL_NAME":"DEXMETHYLPHENIDATE ER 5 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093555101","LABEL_NAME":"DEXMETHYLPHENIDATE ER 10 MG CP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093555201","LABEL_NAME":"DEXMETHYLPHENIDATE ER 15 MG CP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093555301","LABEL_NAME":"DEXMETHYLPHENIDATE ER 20 MG CP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093555401","LABEL_NAME":"DEXMETHYLPHENIDATE ER 30 MG CP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093556201","LABEL_NAME":"DEXMETHYLPHENIDATE ER 40 MG CP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093557101","LABEL_NAME":"ERYTHROMYCIN 250 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093557201","LABEL_NAME":"ERYTHROMYCIN 500 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093590786","LABEL_NAME":"MESALAMINE DR 400 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093593854","LABEL_NAME":"LANTHANUM CARB 500 MG TAB CHEW","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093593985","LABEL_NAME":"LANTHANUM CARB 750 MG TAB CHEW","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093594040","LABEL_NAME":"LANTHANUM CARB 1,000 MG TB CHW","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093598519","LABEL_NAME":"EPINEPHRINE 0.15 MG AUTO-INJCT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093598619","LABEL_NAME":"EPINEPHRINE 0.3 MG AUTO-INJECT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093614882","LABEL_NAME":"CAMRESE LO TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093681519","LABEL_NAME":"BUDESONIDE 0.25 MG/2 ML SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093681619","LABEL_NAME":"BUDESONIDE 0.5 MG/2 ML SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093681719","LABEL_NAME":"BUDESONIDE 1 MG/2 ML INH SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093711306","LABEL_NAME":"NEFAZODONE HCL 150 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093716305","LABEL_NAME":"TOLTERODINE TART ER 2 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093716405","LABEL_NAME":"TOLTERODINE TART ER 4 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093717201","LABEL_NAME":"ETODOLAC ER 500 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093717801","LABEL_NAME":"NEFAZODONE HCL 50 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093719801","LABEL_NAME":"FLUOXETINE HCL 40 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093727105","LABEL_NAME":"PIOGLITAZONE HCL 15 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093727205","LABEL_NAME":"PIOGLITAZONE HCL 30 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093727305","LABEL_NAME":"PIOGLITAZONE HCL 45 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093729001","LABEL_NAME":"RALOXIFENE HCL 60 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093729501","LABEL_NAME":"CARVEDILOL 12.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093729601","LABEL_NAME":"CARVEDILOL 25 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093731405","LABEL_NAME":"CLOPIDOGREL 75 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093735056","LABEL_NAME":"LANSOPRAZOLE DR 15 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093735156","LABEL_NAME":"LANSOPRAZOLE DR 30 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093735301","LABEL_NAME":"CALCITRIOL 0.5 MCG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093736710","LABEL_NAME":"LOSARTAN-HCTZ 50-12.5 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093736810","LABEL_NAME":"LOSARTAN-HCTZ 100-25 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093736910","LABEL_NAME":"LOSARTAN-HCTZ 100-12.5 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093738405","LABEL_NAME":"VENLAFAXINE HCL ER 37.5 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093738505","LABEL_NAME":"VENLAFAXINE HCL ER 75 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093738605","LABEL_NAME":"VENLAFAXINE HCL ER 150 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093738756","LABEL_NAME":"MOXIFLOXACIN HCL 400 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093739286","LABEL_NAME":"NIACIN ER 500 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093739386","LABEL_NAME":"NIACIN ER 750 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093739486","LABEL_NAME":"NIACIN ER 1,000 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093745501","LABEL_NAME":"GLIPIZIDE-METFORMIN 2.5-250 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093745601","LABEL_NAME":"GLIPIZIDE-METFORMIN 2.5-500 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093745701","LABEL_NAME":"GLIPIZIDE-METFORMIN 5-500 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093747119","LABEL_NAME":"RIZATRIPTAN 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093747219","LABEL_NAME":"RIZATRIPTAN 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093747306","LABEL_NAME":"CAPECITABINE 150 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093747489","LABEL_NAME":"CAPECITABINE 500 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093753656","LABEL_NAME":"ANASTROZOLE 1 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093762056","LABEL_NAME":"LETROZOLE 2.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093762998","LABEL_NAME":"IMATINIB MESYLATE 100 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093763056","LABEL_NAME":"IMATINIB MESYLATE 400 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093766256","LABEL_NAME":"ERLOTINIB HCL 25 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093766356","LABEL_NAME":"ERLOTINIB HCL 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093766456","LABEL_NAME":"ERLOTINIB HCL 150 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093770198","LABEL_NAME":"LEVOCETIRIZINE 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093770456","LABEL_NAME":"EMTRICITABINE-TENOFV 200-300MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093777113","LABEL_NAME":"RISEDRONATE SODIUM 150 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093790901","LABEL_NAME":"TIOPRONIN 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093807256","LABEL_NAME":"TIAGABINE HCL 12 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093807656","LABEL_NAME":"TIAGABINE HCL 16 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093811756","LABEL_NAME":"FAMCICLOVIR 125 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093811856","LABEL_NAME":"FAMCICLOVIR 250 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093811956","LABEL_NAME":"FAMCICLOVIR 500 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093816201","LABEL_NAME":"QUETIAPINE FUMARATE 100 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093816301","LABEL_NAME":"QUETIAPINE FUMARATE 200 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093816401","LABEL_NAME":"QUETIAPINE FUMARATE 300 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093816501","LABEL_NAME":"QUETIAPINE FUMARATE 400 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093816601","LABEL_NAME":"QUETIAPINE FUMARATE 50 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093818064","LABEL_NAME":"OSELTAMIVIR 6 MG/ML SUSPENSION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093819201","LABEL_NAME":"CIMETIDINE 300 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093819928","LABEL_NAME":"SUNITINIB MALATE 12.5 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093820401","LABEL_NAME":"CIMETIDINE 400 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093821028","LABEL_NAME":"FINZALA 1-0.02(24)-75 CHEW TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093822428","LABEL_NAME":"SUNITINIB MALATE 25 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093822928","LABEL_NAME":"SUNITINIB MALATE 37.5 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093823128","LABEL_NAME":"SUNITINIB MALATE 50 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093823256","LABEL_NAME":"IRBESARTAN-HCTZ 300-12.5 MG TB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093823856","LABEL_NAME":"IRBESARTAN-HCTZ 150-12.5 MG TB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093830501","LABEL_NAME":"CIMETIDINE 800 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093831018","LABEL_NAME":"ELETRIPTAN HBR 20 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093831118","LABEL_NAME":"ELETRIPTAN HBR 40 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093834201","LABEL_NAME":"GLYBURIDE 1.25 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093834301","LABEL_NAME":"GLYBURIDE 2.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093834401","LABEL_NAME":"GLYBURIDE 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093867574","LABEL_NAME":"AMOX-CLAV 600-42.9 MG/5 ML SUS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093873901","LABEL_NAME":"MEXILETINE 150 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093874001","LABEL_NAME":"MEXILETINE 200 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093874101","LABEL_NAME":"MEXILETINE 250 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093901819","LABEL_NAME":"CYCLOSPORINE MODIFIED 25 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093901919","LABEL_NAME":"CYCLOSPORINE MODIFIED 50 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093902019","LABEL_NAME":"CYCLOSPORINE MODIFIED 100 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093914701","LABEL_NAME":"VENLAFAXINE HCL 25 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093914801","LABEL_NAME":"VENLAFAXINE HCL 37.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093914901","LABEL_NAME":"VENLAFAXINE HCL 50 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093915701","LABEL_NAME":"VENLAFAXINE HCL 75 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093916301","LABEL_NAME":"VENLAFAXINE HCL 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093922201","LABEL_NAME":"DIFLUNISAL 500 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093922489","LABEL_NAME":"MESALAMINE ER 0.375 GRAM CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093929019","LABEL_NAME":"CLONAZEPAM 0.125 MG ODT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093929119","LABEL_NAME":"CLONAZEPAM 0.25 MG ODT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093929219","LABEL_NAME":"CLONAZEPAM 0.5 MG ODT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093929319","LABEL_NAME":"CLONAZEPAM 1 MG ODT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093929419","LABEL_NAME":"CLONAZEPAM 2 MG ODT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093970101","LABEL_NAME":"CARBIDOPA-LEVODOPA 10-100 TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093970201","LABEL_NAME":"CARBIDOPA-LEVODOPA 25-100 TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00093970301","LABEL_NAME":"CARBIDOPA-LEVODOPA 25-250 TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00096070735","LABEL_NAME":"DRYSOL DAB-O-MATIC SOLUTION","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00096070737","LABEL_NAME":"DRYSOL SOLUTION","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00113002026","LABEL_NAME":"GS CHILD PAIN-FEVER 160 MG/5ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00113002562","LABEL_NAME":"GS PAIN RELIEF 500 MG CAPLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00113002809","LABEL_NAME":"GS 24 HOUR ALLERGY 50 MCG SPRY","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00113002925","LABEL_NAME":"GS NICOTINE 2 MG CHEWING GUM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00113005306","LABEL_NAME":"GS NICOTINE 4 MG CHEWING GUM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00113005705","LABEL_NAME":"GS INF IBUPROFEN 50 MG/1.25 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00113008100","LABEL_NAME":"GS MICONAZOLE 3 COMBO PACK","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00113016110","LABEL_NAME":"GS INFANT PAIN-FEVER 160 MG/5","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00113018926","LABEL_NAME":"GS CHILD ALL DAY ALLER 1 MG/ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00113027468","LABEL_NAME":"GS ASPIRIN 81 MG CHEWABLE TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00113029827","LABEL_NAME":"GS IBUPROFEN 200 MG LIQUID GEL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00113030601","LABEL_NAME":"GS CLEARLAX POWDER","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00113030603","LABEL_NAME":"GS CLEARLAX POWDER","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00113034405","LABEL_NAME":"GS NICOTINE 2 MG LOZENGE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00113037926","LABEL_NAME":"GS CHILD ALLERGY 12.5 MG/5 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00113040378","LABEL_NAME":"GS PAIN RELIEF 325 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00113043162","LABEL_NAME":"GS NIGHTTIME SLEEP AID 25 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00113044164","LABEL_NAME":"GS SLEEP AID 25 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00113044301","LABEL_NAME":"GS NASAL ALLERGY 24HR SPRAY","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00113054164","LABEL_NAME":"GS ANTI-ITCH 1% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00113054478","LABEL_NAME":"GS ARTHRITIS PAIN ER 650 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00113060462","LABEL_NAME":"GS IBUPROFEN 200 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00113060826","LABEL_NAME":"GS CHILD FEVER-PAIN 160 MG/5ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00113061239","LABEL_NAME":"GS ALLERGY RELIEF 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00113064771","LABEL_NAME":"GS IBUPROFEN 200 MG CAPLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00113066026","LABEL_NAME":"GS CHILD IBUPROFEN 100 MG/5 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00113067126","LABEL_NAME":"GS CHILD ALLERGY RLF 5 MG/5 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00113073402","LABEL_NAME":"GS NICOTINE 2 MG MINI LOZENGE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00113082529","LABEL_NAME":"GS MICONAZOLE 7 CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00113087305","LABEL_NAME":"GS NICOTINE 4 MG LOZENGE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00113095702","LABEL_NAME":"GS NICOTINE 4 MG MINI LOZENGE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00113098726","LABEL_NAME":"GS CHILDREN'S COLD-COUGH SOLN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00113200312","LABEL_NAME":"OPTION 2 1.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00113246162","LABEL_NAME":"GS IBUPROFEN 100 MG CHEW TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00113403262","LABEL_NAME":"GS SLEEP AID ULTRA 25 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00113810101","LABEL_NAME":"OPILL 0.075 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00113945813","LABEL_NAME":"GS ALL DAY ALLERGY 10 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00115107001","LABEL_NAME":"DIPYRIDAMOLE 25 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00115107101","LABEL_NAME":"DIPYRIDAMOLE 50 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00115107201","LABEL_NAME":"DIPYRIDAMOLE 75 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00115132510","LABEL_NAME":"FENOFIBRIC ACID DR 135 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00115140408","LABEL_NAME":"PYRIDOSTIGMINE ER 180 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00115140801","LABEL_NAME":"METHYLTESTOSTERONE 10 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00115148601","LABEL_NAME":"DEXTROAMP-AMPHET ER 5 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00115148701","LABEL_NAME":"DEXTROAMP-AMPHET ER 10 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00115148801","LABEL_NAME":"DEXTROAMP-AMPHET ER 15 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00115148901","LABEL_NAME":"DEXTROAMP-AMPHET ER 20 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00115149001","LABEL_NAME":"DEXTROAMP-AMPHET ER 25 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00115149101","LABEL_NAME":"DEXTROAMP-AMPHET ER 30 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00115164501","LABEL_NAME":"NITROFURANTOIN MCR 100 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00115165901","LABEL_NAME":"PROPRANOLOL 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00115166001","LABEL_NAME":"PROPRANOLOL 20 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00115166101","LABEL_NAME":"PROPRANOLOL 40 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00115166201","LABEL_NAME":"PROPRANOLOL 80 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00115169301","LABEL_NAME":"PROPRANOLOL 60 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00115169606","LABEL_NAME":"HYDROCORTISONE 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00115169701","LABEL_NAME":"HYDROCORTISONE 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00115170001","LABEL_NAME":"HYDROCORTISONE 20 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00115172401","LABEL_NAME":"GRISEOFULVIN ULTRA 125 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00115172501","LABEL_NAME":"GRISEOFULVIN ULTRA 250 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00115173601","LABEL_NAME":"METHYLPHENIDATE ER(CD) 10MG CP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00115173701","LABEL_NAME":"METHYLPHENIDATE ER(CD) 20MG CP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00115173801","LABEL_NAME":"METHYLPHENIDATE ER(CD) 30MG CP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00115173901","LABEL_NAME":"METHYLPHENIDATE ER(CD) 40MG CP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00115174001","LABEL_NAME":"METHYLPHENIDATE ER(CD) 50MG CP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00115174101","LABEL_NAME":"METHYLPHENIDATE ER(CD) 60MG CP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00115175701","LABEL_NAME":"CYPROHEPTADINE 4 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00115180301","LABEL_NAME":"HYDROXYZINE PAM 25 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00115180401","LABEL_NAME":"HYDROXYZINE PAM 50 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00115191101","LABEL_NAME":"RIMANTADINE HCL 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00115202310","LABEL_NAME":"NITROFURANTOIN MCR 50 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00115261101","LABEL_NAME":"TERBUTALINE SULFATE 2.5 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00115279006","LABEL_NAME":"CHLOROQUINE PH 250 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00115351101","LABEL_NAME":"PYRIDOSTIGMINE BR 60 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00115441101","LABEL_NAME":"DANTROLENE SODIUM 25 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00115442201","LABEL_NAME":"DANTROLENE SODIUM 50 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00115443301","LABEL_NAME":"DANTROLENE SODIUM 100 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00115521116","LABEL_NAME":"COLESTIPOL HCL 1 GM TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00115521218","LABEL_NAME":"COLESTIPOL HCL GRANULES PACKET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00115521302","LABEL_NAME":"COLESTIPOL HCL GRANULES","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00115551110","LABEL_NAME":"FENOFIBRATE 54 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00115552202","LABEL_NAME":"FENOFIBRATE 160 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00115592201","LABEL_NAME":"PILOCARPINE HCL 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00115701009","LABEL_NAME":"CHLOROQUINE PH 500 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00115703301","LABEL_NAME":"FLUDROCORTISONE 0.1 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00116200104","LABEL_NAME":"CHLORHEXIDINE 0.12% RINSE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00116200106","LABEL_NAME":"CHLORHEXIDINE 0.12%  15 ML CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00116400508","LABEL_NAME":"LACTULOSE 10 GM/15 ML SOLUTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00116400511","LABEL_NAME":"LACTULOSE 20 GM/30 ML SOLN CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00116400515","LABEL_NAME":"LACTULOSE 10 GM/15 ML SOLN CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00116401010","LABEL_NAME":"AMANTADINE 100 MG/10 ML CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00116401016","LABEL_NAME":"AMANTADINE 50 MG/5 ML SOLUTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00116402316","LABEL_NAME":"PROMETHAZINE 6.25 MG/5 ML SYRP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00116402416","LABEL_NAME":"PROMETHAZINE-DM 6.25-15 MG/5ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00121043130","LABEL_NAME":"MILK OF MAGNESIA SUSPENSION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00121050405","LABEL_NAME":"ACETAMINOP-CODEINE 120-12 MG/5","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00121058104","LABEL_NAME":"HALOPERIDOL LAC 2 MG/ML CONC","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00121058105","LABEL_NAME":"HALOPERIDOL LAC 10 MG/5 ML CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00121065304","LABEL_NAME":"FLUPHENAZINE 5 MG/ML CONC","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00121065402","LABEL_NAME":"FLUPHENAZINE 2.5 MG/5 ML ELIX","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00121065700","LABEL_NAME":"ACETAMINOPHEN 160 MG/5 ML CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00121065816","LABEL_NAME":"TRIHEXYPHENIDYL 2 MG/5 ML SOLN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00121067016","LABEL_NAME":"ETHOSUXIMIDE 250 MG/5 ML SOLN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00121067585","LABEL_NAME":"VALPROIC ACID 250 MG/5 ML SOLN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00121067816","LABEL_NAME":"NORTRIPTYLINE 10 MG/5 ML SOLN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00121075908","LABEL_NAME":"PREDNISOLONE 15 MG/5 ML SOLN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00121077001","LABEL_NAME":"LORAZEPAM 2 MG/ML ORAL CONCENT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00121077504","LABEL_NAME":"GUAIFEN-CODEINE 100-10 MG/5 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00121079916","LABEL_NAME":"LEVETIRACETAM 100 MG/ML SOLN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00121083300","LABEL_NAME":"CHILD IBUPROFEN 100 MG/5ML CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00121085320","LABEL_NAME":"SULFAMETHOXAZOLE-TMP 20 ML CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00121085416","LABEL_NAME":"SULFATRIM PEDIATRIC SUSPENSION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00121086500","LABEL_NAME":"DIPHENHYDRAMINE 12.5MG/5ML CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00121086800","LABEL_NAME":"NYSTATIN 500,000 UNIT/5 ML CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00121086802","LABEL_NAME":"NYSTATIN 100,000 UNIT/ML SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00121087404","LABEL_NAME":"CETIRIZINE HCL 1 MG/ML SOLN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00121088508","LABEL_NAME":"PREDNISOLONE 15 MG/5 ML SOLN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00121090405","LABEL_NAME":"MORPHINE SULF 10 MG/5 ML CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00121094000","LABEL_NAME":"MILK OF MAGNESIA CONC 10ML CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00121094205","LABEL_NAME":"PHENOBARBITAL 20 MG/5 ML CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00121094216","LABEL_NAME":"PHENOBARBITAL 20 MG/5 ML SOLN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00121094816","LABEL_NAME":"POTASSIUM CL 10% (20 MEQ/15ML)","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00121095608","LABEL_NAME":"ATOVAQUONE 750 MG/5 ML SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00121096600","LABEL_NAME":"CHLD ACETAMINOPHEN 160 MG/5 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00121097400","LABEL_NAME":"SUCRALFATE 1 GM/10 ML SUSP CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00121100230","LABEL_NAME":"LIDOCAINE-PRILOCAINE CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00121100812","LABEL_NAME":"ACETAMIN-CODEIN 300-30 MG/12.5","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00121101205","LABEL_NAME":"LACOSAMIDE 50 MG/5 ML CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00121101605","LABEL_NAME":"ATOVAQUONE 750 MG/5ML SUSP CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00121102508","LABEL_NAME":"CIMETIDINE 300 MG/5 ML SOLN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00121103416","LABEL_NAME":"HYDROXYZINE 10 MG/5 ML SYRUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00121103800","LABEL_NAME":"MEGESTROL 400 MG/10ML SUSP CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00121106716","LABEL_NAME":"GABAPENTIN 250 MG/5 ML SOLN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00121131400","LABEL_NAME":"ACETAMINOPHEN 325 MG/10.15 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00121135000","LABEL_NAME":"VALPROIC ACID 500 MG/10 ML CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00121148800","LABEL_NAME":"GUAIFENESIN 200 MG/10 ML CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00121154410","LABEL_NAME":"HYDROCODONE-ACETAMIN 5-217/10","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00121155010","LABEL_NAME":"GUAIFEN-CODEINE 200-20 MG/10ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00121157610","LABEL_NAME":"METOCLOPRAMIDE 10 MG/10 ML CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00121159810","LABEL_NAME":"LEVETIRACETAM 1,000MG/10ML CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00121166600","LABEL_NAME":"CHILD IBUPROFEN 200MG/10ML CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00121173000","LABEL_NAME":"DIPHENHYDRAMINE 25 MG/10ML CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00121174400","LABEL_NAME":"GUAIFENESIN 100MG/5ML SOLN CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00121177505","LABEL_NAME":"GUAIFEN-CODEINE 100-10 MG/5 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00121185416","LABEL_NAME":"PROMETHAZINE 6.25 MG/5 ML SOLN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00121188407","LABEL_NAME":"PHENOBARBITAL 30 MG/7.5 ML CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00121189600","LABEL_NAME":"POTASSIUM CL10%(40MEQ/30ML)CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00121197100","LABEL_NAME":"ACETAMINOPHEN 650MG/20.3ML CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00121202410","LABEL_NAME":"LACOSAMIDE 100 MG/10 ML CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00121210602","LABEL_NAME":"LEUPROLIDE 2WK 14 MG/2.8 ML KT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00121213406","LABEL_NAME":"GABAPENTIN 300 MG/6ML SOLN CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00121223200","LABEL_NAME":"GUAIFENESIN 300 MG/15 ML CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00121231615","LABEL_NAME":"HYDROCODONE-ACETAMN 7.5-325/15","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00121282615","LABEL_NAME":"PHENOBARBITAL 60 MG/15 ML CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00121303615","LABEL_NAME":"LACOSAMIDE 150 MG/15 ML CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00121404874","LABEL_NAME":"LACOSAMIDE 200 MG/20 ML CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00121406705","LABEL_NAME":"GABAPENTIN 250 MG/5ML SOLN CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00121467500","LABEL_NAME":"VALPROIC ACID 250 MG/5 ML CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00121472105","LABEL_NAME":"FLUOXETINE 20 MG/5 ML SOLN CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00121475905","LABEL_NAME":"PREDNISOLONE 15MG/5ML SOLN CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00121477205","LABEL_NAME":"HYDROCODONE-ACETAMIN 2.5-108/5","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00121479905","LABEL_NAME":"LEVETIRACETAM 500 MG/5 ML CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00121482705","LABEL_NAME":"OXYCODONE HCL 5 MG/5 ML CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00121494800","LABEL_NAME":"POTASSIUM CL10%(20MEQ/15ML)CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00121495015","LABEL_NAME":"LIDOCAINE 2% VISCOUS 15 ML CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00126003516","LABEL_NAME":"PERIOGARD 0.12% ORAL RINSE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00132000047","LABEL_NAME":"FLEET BISACODYL EC 5 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00132000048","LABEL_NAME":"FLEET DOCUSATE 100 MG SOFTGEL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00143117101","LABEL_NAME":"CAPTOPRIL 12.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00143117201","LABEL_NAME":"CAPTOPRIL 25 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00143117301","LABEL_NAME":"CAPTOPRIL 50 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00143117401","LABEL_NAME":"CAPTOPRIL 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00143122701","LABEL_NAME":"DICYCLOMINE 20 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00143124001","LABEL_NAME":"DIGOXIN 125 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00143124101","LABEL_NAME":"DIGOXIN 250 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00143145501","LABEL_NAME":"PHENOBARBITAL 60 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00143145801","LABEL_NAME":"PHENOBARBITAL 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00143149501","LABEL_NAME":"PHENOBARBITAL 15 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00143150001","LABEL_NAME":"PHENOBARBITAL 30 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00143176901","LABEL_NAME":"ISOSORBIDE DINITRATE 5 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00143177101","LABEL_NAME":"ISOSORBIDE DINITRATE 10 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00143177201","LABEL_NAME":"ISOSORBIDE DINITRATE 20 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00143211205","LABEL_NAME":"DOXYCYCLINE HYCLATE 100 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00143314250","LABEL_NAME":"DOXYCYCLINE HYCLATE 100 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00143900501","LABEL_NAME":"TESTOSTERONE CYP 2,000 MG/10ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00143927301","LABEL_NAME":"DIHYDROERGOTAMINE 1 MG/ML AMP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00143929501","LABEL_NAME":"HALOPERIDOL DEC 100 MG/ML VIAL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00143929601","LABEL_NAME":"HALOPERIDOL DEC 500 MG/5 ML VL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00143950101","LABEL_NAME":"HALOPERIDOL LAC 5 MG/ML VIAL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00143950201","LABEL_NAME":"HALOPERIDOL LAC 50 MG/10 ML VL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00143951901","LABEL_NAME":"METHOTREXATE 50 MG/2 ML VIAL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00143952901","LABEL_NAME":"FLUPHENAZINE DEC 125 MG/5 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00143959721","LABEL_NAME":"ABIRATERONE ACETATE 250 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00143961901","LABEL_NAME":"CYANOCOBALAMIN 30,000 MCG/30ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00143962001","LABEL_NAME":"CYANOCOBALAMIN 10,000 MCG/10ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00143962101","LABEL_NAME":"CYANOCOBALAMIN 1,000 MCG/ML VL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00143963801","LABEL_NAME":"SUMATRIPTAN 6 MG/0.5 ML VIAL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00143965901","LABEL_NAME":"TESTOSTERONE CYP 200 MG/ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00143972501","LABEL_NAME":"PROGESTERONE 500 MG/10 ML VIAL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00143975001","LABEL_NAME":"TESTOSTERON ENAN 1,000 MG/5 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00143980250","LABEL_NAME":"DOXYCYCLINE HYCLATE 50 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00143988801","LABEL_NAME":"AMOXICILLIN 125 MG/5 ML SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00143992701","LABEL_NAME":"CIPROFLOXACIN HCL 250 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00143992950","LABEL_NAME":"CIPROFLOXACIN HCL 750 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00168000215","LABEL_NAME":"TRIAMCINOLONE 0.5% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00168000315","LABEL_NAME":"TRIAMCINOLONE 0.025% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00168000415","LABEL_NAME":"TRIAMCINOLONE 0.1% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00168000580","LABEL_NAME":"TRIAMCINOLONE 0.025% OINT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00168000615","LABEL_NAME":"TRIAMCINOLONE 0.1% OINTMENT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00168003315","LABEL_NAME":"BETAMETHASONE VALER 0.1% OINTM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00168004015","LABEL_NAME":"BETAMETHASONE VA 0.1% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00168004160","LABEL_NAME":"BETAMETHASONE VA 0.1% LOTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00168005515","LABEL_NAME":"BETAMETHASONE DP 0.05% CRM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00168005615","LABEL_NAME":"BETAMETHASONE DP 0.05% OINT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00168005760","LABEL_NAME":"BETAMETHASONE DP 0.05% LOT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00168005960","LABEL_NAME":"FLUOCINOLONE 0.01% SOLUTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00168006415","LABEL_NAME":"FLUOCINOLONE 0.025% OINTMENT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00168008016","LABEL_NAME":"HYDROCORTISONE 2.5% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00168013460","LABEL_NAME":"FLUOCINONIDE 0.05% SOLUTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00168014616","LABEL_NAME":"HYDROCORTISONE 2.5% OINTMENT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00168016315","LABEL_NAME":"CLOBETASOL 0.05% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00168020130","LABEL_NAME":"CLINDAMYCIN PH 1% SOLUTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00168020230","LABEL_NAME":"CLINDAMYCIN PH 1% GEL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00168020360","LABEL_NAME":"CLINDAMYCIN PHOSP 1% LOTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00168020437","LABEL_NAME":"LIDOCAINE 5% OINTMENT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00168025815","LABEL_NAME":"CLOTRIMAZOLE-BETAMETHASONE CRM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00168026360","LABEL_NAME":"ALCLOMETASONE DIPRO 0.05% CRM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00168026815","LABEL_NAME":"BETAMETHASONE DP AUG 0.05% OIN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00168026950","LABEL_NAME":"CLOBETASOL 0.05% SOLUTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00168027740","LABEL_NAME":"CLINDAMYCIN 2% VAGINAL CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00168029315","LABEL_NAME":"CLOBETASOL 0.05% GEL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00168030115","LABEL_NAME":"CLOBETASOL EMOLLIENT 0.05% CRM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00168032346","LABEL_NAME":"METRONIDAZOLE 0.75% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00168034646","LABEL_NAME":"TERCONAZOLE 0.4% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00168034720","LABEL_NAME":"TERCONAZOLE 0.8% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00168041630","LABEL_NAME":"TACROLIMUS 0.1% OINTMENT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00168041730","LABEL_NAME":"TACROLIMUS 0.03% OINTMENT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00168042446","LABEL_NAME":"ADAPALENE 0.1% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00169203011","LABEL_NAME":"SOGROYA 10 MG/1.5 ML PEN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00169203511","LABEL_NAME":"SOGROYA 5 MG/1.5 ML PEN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00169203711","LABEL_NAME":"SOGROYA 15 MG/1.5 ML PEN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00169208015","LABEL_NAME":"ALHEMO 150 MG/1.5 ML PEN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00169208103","LABEL_NAME":"ALHEMO 300 MG/3 ML PEN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00169208415","LABEL_NAME":"ALHEMO 60 MG/1.5 ML PEN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00169291115","LABEL_NAME":"XULTOPHY 100 UNIT-3.6MG/ML PEN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00169413001","LABEL_NAME":"OZEMPIC 1 MG/DOSE (4 MG/3 ML)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00169418113","LABEL_NAME":"OZEMPIC 0.25-0.5 MG/DOSE PEN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00169430330","LABEL_NAME":"RYBELSUS 3 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00169430730","LABEL_NAME":"RYBELSUS 7 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00169431430","LABEL_NAME":"RYBELSUS 14 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00169477211","LABEL_NAME":"OZEMPIC 2 MG/DOSE (8 MG/3 ML)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00169530610","LABEL_NAME":"RIVFLOZA 160 MG/ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00169530708","LABEL_NAME":"RIVFLOZA 128 MG/0.8 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00169530801","LABEL_NAME":"RIVFLOZA 80 MG/0.5 ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00169770421","LABEL_NAME":"NORDITROPIN FLEXPRO 5 MG/1.5","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00169770521","LABEL_NAME":"NORDITROPIN FLEXPRO 10 MG/1.5","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00169770821","LABEL_NAME":"NORDITROPIN FLEXPRO 15 MG/1.5","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00172208360","LABEL_NAME":"HYDROCHLOROTHIAZIDE 25 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00172208960","LABEL_NAME":"HYDROCHLOROTHIAZIDE 50 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00172344460","LABEL_NAME":"HYDROCHLOROTHIAZIDE 12.5 MG TB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00172376260","LABEL_NAME":"LISINOPRIL 30 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00172392560","LABEL_NAME":"DIAZEPAM 2 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00172392660","LABEL_NAME":"DIAZEPAM 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00172392760","LABEL_NAME":"DIAZEPAM 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00172409660","LABEL_NAME":"BACLOFEN 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00172409760","LABEL_NAME":"BACLOFEN 20 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00172572860","LABEL_NAME":"FAMOTIDINE 20 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00172572960","LABEL_NAME":"FAMOTIDINE 40 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00172640649","LABEL_NAME":"CROMOLYN 20 MG/2 ML NEB SOLN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00172731320","LABEL_NAME":"CYCLOSPORINE MODIFIED 100MG/ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00173052100","LABEL_NAME":"SEREVENT DISKUS 50 MCG","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00173068220","LABEL_NAME":"VENTOLIN HFA 90 MCG INHALER","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00173071520","LABEL_NAME":"ADVAIR HFA 45-21 MCG INHALER","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00173071620","LABEL_NAME":"ADVAIR HFA 115-21 MCG INHALER","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00173071720","LABEL_NAME":"ADVAIR HFA 230-21 MCG INHALER","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00173085910","LABEL_NAME":"BREO ELLIPTA 100-25 MCG INHALR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00173086906","LABEL_NAME":"ANORO ELLIPTA 62.5-25 MCG INH","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00173087306","LABEL_NAME":"INCRUSE ELLIPTA 62.5 MCG INH","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00173087410","LABEL_NAME":"ARNUITY ELLIPTA 100 MCG INH","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00173087610","LABEL_NAME":"ARNUITY ELLIPTA 200 MCG INH","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00173088101","LABEL_NAME":"NUCALA 100 MG/ML POWDER VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00173088210","LABEL_NAME":"BREO ELLIPTA 200-25 MCG INHALR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00173088710","LABEL_NAME":"TRELEGY ELLIPTA 100-62.5-25","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00173088810","LABEL_NAME":"ARNUITY ELLIPTA 50 MCG INH","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00173088939","LABEL_NAME":"KRINTAFEL 150 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00173089201","LABEL_NAME":"NUCALA 100 MG/ML AUTO-INJECTOR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00173089242","LABEL_NAME":"NUCALA 100 MG/ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00173089310","LABEL_NAME":"TRELEGY ELLIPTA 200-62.5-25","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00173090442","LABEL_NAME":"NUCALA 40 MG/0.4 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00173090913","LABEL_NAME":"ZEJULA 100 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00173091213","LABEL_NAME":"ZEJULA 200 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00173091513","LABEL_NAME":"ZEJULA 300 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00173091610","LABEL_NAME":"BREO ELLIPTA 50-25 MCG INHALER","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00179801430","LABEL_NAME":"CLOTRIMAZOLE 1% TOPICAL CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00179801730","LABEL_NAME":"MICONAZOLE 2% TOPICAL CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00179805002","LABEL_NAME":"FOLIC ACID 800 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00179806102","LABEL_NAME":"VITAMIN B-6 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00179815001","LABEL_NAME":"BISACODYL EC 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00179870260","LABEL_NAME":"BENZOYL PEROXIDE 5% GEL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00179870360","LABEL_NAME":"BENZOYL PEROXIDE 10% GEL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00179870405","LABEL_NAME":"BENZOYL PEROXIDE 10% WASH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00179870505","LABEL_NAME":"BENZOYL PEROXIDE 5% WASH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00179871530","LABEL_NAME":"TERBINAFINE 1% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00185002201","LABEL_NAME":"ORPHENADRINE ER 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00185005501","LABEL_NAME":"METOLAZONE 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00185012201","LABEL_NAME":"NITROFURANTOIN MONO-MCR 100 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00185012801","LABEL_NAME":"BUMETANIDE 0.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00185012901","LABEL_NAME":"BUMETANIDE 1 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00185013001","LABEL_NAME":"BUMETANIDE 2 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00185021101","LABEL_NAME":"BENAZEPRIL-HCTZ 20-12.5 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00185023601","LABEL_NAME":"BENAZEPRIL-HCTZ 5-6.25 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00185027701","LABEL_NAME":"BENAZEPRIL-HCTZ 20-25 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00185032501","LABEL_NAME":"BENAZEPRIL-HCTZ 10-12.5 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00185084201","LABEL_NAME":"DEXTROAMP-AMPHETAMIN 10 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00185085301","LABEL_NAME":"DEXTROAMP-AMPHETAMIN 20 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00185209801","LABEL_NAME":"DEXTROAMP-AMPHETAMINE 5 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00185209901","LABEL_NAME":"DEXTROAMP-AMPHETAMIN 30 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00185505001","LABEL_NAME":"METOLAZONE 2.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00185560001","LABEL_NAME":"METOLAZONE 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00187000400","LABEL_NAME":"SILIQ 210 MG/1.5 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00193280221","LABEL_NAME":"DIASTIX REAGENT STRIPS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00193288221","LABEL_NAME":"KETO-DIASTIX REAGENT STRIPS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00193596531","LABEL_NAME":"FINGERSTIX LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00193654621","LABEL_NAME":"MICROLET LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00193656801","LABEL_NAME":"SINGLE-LET LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00193660601","LABEL_NAME":"MICROLET 2 LANCING DEVICE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00193670201","LABEL_NAME":"MICROLET NEXT LANCING DEVICE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00225029515","LABEL_NAME":"ANASPAZ 0.125 MG TABLET ODT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00228202710","LABEL_NAME":"ALPRAZOLAM 0.25 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00228202910","LABEL_NAME":"ALPRAZOLAM 0.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00228203110","LABEL_NAME":"ALPRAZOLAM 1 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00228203910","LABEL_NAME":"ALPRAZOLAM 2 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00228206710","LABEL_NAME":"OXAZEPAM 10 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00228206910","LABEL_NAME":"OXAZEPAM 15 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00228207310","LABEL_NAME":"OXAZEPAM 30 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00228207610","LABEL_NAME":"TEMAZEPAM 15 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00228207710","LABEL_NAME":"TEMAZEPAM 30 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00228212710","LABEL_NAME":"CLONIDINE HCL 0.1 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00228212810","LABEL_NAME":"CLONIDINE HCL 0.2 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00228212910","LABEL_NAME":"CLONIDINE HCL 0.3 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00228255006","LABEL_NAME":"DICLOFENAC SOD EC 50 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00228255106","LABEL_NAME":"DICLOFENAC SOD EC 75 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00228257111","LABEL_NAME":"INDAPAMIDE 2.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00228259711","LABEL_NAME":"INDAPAMIDE 1.25 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00228277811","LABEL_NAME":"PROPRANOLOL ER 60 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00228277911","LABEL_NAME":"PROPRANOLOL ER 80 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00228278011","LABEL_NAME":"PROPRANOLOL ER 120 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00228278111","LABEL_NAME":"PROPRANOLOL ER 160 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00228283711","LABEL_NAME":"PILOCARPINE HCL 7.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00228285011","LABEL_NAME":"GUANFACINE HCL ER 1 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00228285111","LABEL_NAME":"GUANFACINE HCL ER 2 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00228285311","LABEL_NAME":"GUANFACINE HCL ER 3 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00228285511","LABEL_NAME":"GUANFACINE HCL ER 4 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00228289006","LABEL_NAME":"DULOXETINE HCL DR 20 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00228289103","LABEL_NAME":"DULOXETINE HCL DR 30 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00228289203","LABEL_NAME":"DULOXETINE HCL DR 60 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00228364003","LABEL_NAME":"ROPINIROLE HCL ER 6 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00228365803","LABEL_NAME":"ROPINIROLE HCL ER 2 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00228365903","LABEL_NAME":"ROPINIROLE HCL ER 4 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00228366003","LABEL_NAME":"ROPINIROLE HCL ER 8 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00228366103","LABEL_NAME":"ROPINIROLE HCL ER 12 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00228401911","LABEL_NAME":"ALPRAZOLAM ODT 0.25 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00228402211","LABEL_NAME":"ALPRAZOLAM ODT 0.5 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00228402411","LABEL_NAME":"ALPRAZOLAM ODT 1 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00228402511","LABEL_NAME":"ALPRAZOLAM ODT 2 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00228424106","LABEL_NAME":"CLONIDINE HCL ER 0.1 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00245003623","LABEL_NAME":"PREVALITE POWDER","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00245003642","LABEL_NAME":"PREVALITE PACKET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00245014430","LABEL_NAME":"PACERONE 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00245014715","LABEL_NAME":"PACERONE 200 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00245021111","LABEL_NAME":"MIDODRINE HCL 2.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00245021201","LABEL_NAME":"MIDODRINE HCL 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00245021311","LABEL_NAME":"MIDODRINE HCL 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00245055650","LABEL_NAME":"VIGADRONE 500 MG POWDER PACKET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00245081411","LABEL_NAME":"KYMBEE 6 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00245081530","LABEL_NAME":"KYMBEE 18 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00245081630","LABEL_NAME":"KYMBEE 30 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00245081730","LABEL_NAME":"KYMBEE 36 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00245082230","LABEL_NAME":"TORPENZ 2.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00245082330","LABEL_NAME":"TORPENZ 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00245082430","LABEL_NAME":"TORPENZ 7.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00245082530","LABEL_NAME":"TORPENZ 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00245083601","LABEL_NAME":"KLOR-CON 10 MEQ TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00245086070","LABEL_NAME":"VANDAZOLE VAGINAL 0.75% GEL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00245531501","LABEL_NAME":"KLOR-CON 8 MEQ TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00245531701","LABEL_NAME":"KLOR-CON M10 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00245531901","LABEL_NAME":"KLOR-CON M20 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00245600111","LABEL_NAME":"VIGADRONE 500 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00254200001","LABEL_NAME":"PENICILLAMINE 250 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00254204502","LABEL_NAME":"POSACONAZOLE DR 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00254302002","LABEL_NAME":"NITISINONE 2 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00254302102","LABEL_NAME":"NITISINONE 5 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00254302202","LABEL_NAME":"NITISINONE 10 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00254302802","LABEL_NAME":"LUBIPROSTONE 8 MCG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00254302902","LABEL_NAME":"LUBIPROSTONE 24 MCG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00254303430","LABEL_NAME":"TIOPRONIN DR 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00254303509","LABEL_NAME":"TIOPRONIN DR 300 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00259160501","LABEL_NAME":"XEOMIN 50 UNIT VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00259161001","LABEL_NAME":"XEOMIN 100 UNIT VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00259162001","LABEL_NAME":"XEOMIN 200 UNIT VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00264220100","LABEL_NAME":"SODIUM CHLORIDE 0.9% IRRIG.","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00280210012","LABEL_NAME":"BAYER LOW DOSE EC 81 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00281032608","LABEL_NAME":"NITRO-BID 2% OINTMENT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00299596230","LABEL_NAME":"DYSPORT 300 UNIT VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00299622015","LABEL_NAME":"NEMLUVIO 30 MG PEN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00310061028","LABEL_NAME":"KOSELUGO 10 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00310062528","LABEL_NAME":"KOSELUGO 25 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00310063560","LABEL_NAME":"KOSELUGO 5 MG SPRINKLE CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00310064060","LABEL_NAME":"KOSELUGO 7.5 MG SPRINKLE CAP","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00310066812","LABEL_NAME":"LYNPARZA 100 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00310067912","LABEL_NAME":"LYNPARZA 150 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00310110501","LABEL_NAME":"LOKELMA 5 GRAM POWDER PACKET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00310111001","LABEL_NAME":"LOKELMA 10 GRAM POWDER PACKET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00310134930","LABEL_NAME":"TAGRISSO 40 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00310135030","LABEL_NAME":"TAGRISSO 80 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00310173030","LABEL_NAME":"FASENRA 30 MG/ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00310174501","LABEL_NAME":"FASENRA 10 MG/0.5 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00310183030","LABEL_NAME":"FASENRA PEN 30 MG/ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00310351260","LABEL_NAME":"CALQUENCE 100 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00310620530","LABEL_NAME":"FARXIGA 5 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00310621030","LABEL_NAME":"FARXIGA 10 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00310622560","LABEL_NAME":"XIGDUO XR 2.5 MG-1,000 MG TAB","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00310625030","LABEL_NAME":"XIGDUO XR 5 MG-500 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00310626060","LABEL_NAME":"XIGDUO XR 5 MG-1,000 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00310627030","LABEL_NAME":"XIGDUO XR 10 MG-500 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00310628030","LABEL_NAME":"XIGDUO XR 10 MG-1,000 MG TAB","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00310737020","LABEL_NAME":"BUDESONIDE-FORMOTEROL 160-4.5","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00310737220","LABEL_NAME":"BUDESONIDE-FORMOTEROL 80-4.5","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00310940001","LABEL_NAME":"WAINUA 45 MG/0.8 ML AUTOINJECT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00310950002","LABEL_NAME":"TRUQAP 160 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00310950101","LABEL_NAME":"TRUQAP 200 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00316017516","LABEL_NAME":"TRIDERM 0.5% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00316022855","LABEL_NAME":"PANOXYL 10% ACNE FOAMING WASH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00316023125","LABEL_NAME":"ZEASORB AF 2% POWDER","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00338005047","LABEL_NAME":"SODIUM CHLORIDE 0.9% PRCSS SOL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00363005705","LABEL_NAME":"INFANT IBUPROFEN 50 MG/1.25 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363008100","LABEL_NAME":"MICONAZOLE 3 COMBO PACK","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363008501","LABEL_NAME":"CHILD WAL-ITIN 5 MG/5 ML SYRUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363008816","LABEL_NAME":"WAL-ITIN 5 MG/5 ML SYRUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363009208","LABEL_NAME":"CHILD'S WAL-DRYL 12.5 MG/5 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363010301","LABEL_NAME":"INFANT PAIN-FEVER 160 MG/5 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363010412","LABEL_NAME":"PAIN RELIEVER 325 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363010526","LABEL_NAME":"NON-ASPIRIN 160 MG/5 ML SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363010540","LABEL_NAME":"CHILD PAIN RLF 160 MG/5 ML SUS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363010612","LABEL_NAME":"WAL-DRYL ALLERGY 12.5 MG/5 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363010706","LABEL_NAME":"WAL-DRYL ALLERGY 25 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363012020","LABEL_NAME":"IBUPROFEN 200 MG SOFTGEL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363012612","LABEL_NAME":"ORAL SALINE LAXATIVE LIQUID","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363013338","LABEL_NAME":"MAGNESIUM CITRATE SOLUTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363016204","LABEL_NAME":"CHILD PAIN RLF 160 MG/5 ML SUS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363017508","LABEL_NAME":"PAIN RELIEVER 500 MG CAPLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363018601","LABEL_NAME":"NON-ASPIRIN 80 MG TAB CHEW","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363019005","LABEL_NAME":"NICOTINE 4 MG LOZENGE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363019602","LABEL_NAME":"NICOTINE 7 MG/24HR PATCH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363020105","LABEL_NAME":"NICOTINE 2 MG LOZENGE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363021807","LABEL_NAME":"ASPIRIN 81 MG CHEWABLE TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363025510","LABEL_NAME":"INFANT IBUPROFEN 50 MG/1.25 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363025514","LABEL_NAME":"ASPIRIN EC 81 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363028826","LABEL_NAME":"CHILDREN'S CHEST CONGEST LIQ","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363029108","LABEL_NAME":"WAL-PROFEN 200 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363029116","LABEL_NAME":"IBUPROFEN 200 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363029214","LABEL_NAME":"IBUPROFEN 200 MG CAPLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363029215","LABEL_NAME":"WAL-PROFEN 200 MG CAPLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363029908","LABEL_NAME":"WAL-DRYL ALLERGY 25 MG SOFTGEL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363030602","LABEL_NAME":"SMOOTHLAX POWDER","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363030603","LABEL_NAME":"SMOOTHLAX POWDER","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363030652","LABEL_NAME":"SMOOTHLAX POWDER PACKET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363031026","LABEL_NAME":"ADULT WAL-TUSSIN LIQUID","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363032003","LABEL_NAME":"SALINE 0.65% NASAL SPRAY","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363032712","LABEL_NAME":"GENTLE LAXATIVE EC 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363033304","LABEL_NAME":"ARTHRITIS PAIN ER 650 MG CAPLT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363033601","LABEL_NAME":"PAIN RELIEVER ER 650 MG CAPLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363034190","LABEL_NAME":"ATHLETE'S FOOT 2% POWDER SPRAY","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363035278","LABEL_NAME":"NICOTINE 2 MG CHEWING GUM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363038421","LABEL_NAME":"COUGH DM ER 30 MG/5 ML SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363042113","LABEL_NAME":"NICOTINE 4 MG CHEWING GUM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363044167","LABEL_NAME":"WAL-SOM 25 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363044701","LABEL_NAME":"ACETAMINOPHEN 80 MG RAPID TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363044908","LABEL_NAME":"JUNIOR PAIN RELIEVER 160 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363045008","LABEL_NAME":"JR PAIN-FEVER 160 MG RAPID TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363045802","LABEL_NAME":"WAL-ZYR 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363047526","LABEL_NAME":"CHILD WAL-ZYR 1 MG/ML SOLUTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363051908","LABEL_NAME":"PAIN RELIEVER 500 MG GELCAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363052278","LABEL_NAME":"WAL-ITIN 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363053112","LABEL_NAME":"PAIN RELIEVER 500 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363053201","LABEL_NAME":"MUCUS RELIEF 400 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363056314","LABEL_NAME":"ASPIRIN EC 81 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363061501","LABEL_NAME":"WAL-ZYR 0.025% EYE DROPS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363062712","LABEL_NAME":"SLEEP AID 25 MG CAPLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363066026","LABEL_NAME":"IBUPROFEN 100 MG/5 ML SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363070653","LABEL_NAME":"CHILD FEVER REDUCER 120 MG SUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363073402","LABEL_NAME":"NICOTINE 2 MG MINI LOZENGE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363073745","LABEL_NAME":"MICONAZOLE 1 COMBINATION PACK","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363075934","LABEL_NAME":"CHILD PAIN-FEVER 160 MG/5 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363092301","LABEL_NAME":"EYE ITCH RELIEF 0.025% DROPS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363093604","LABEL_NAME":"WAL-ZYR SOLUTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363095702","LABEL_NAME":"NICOTINE 4 MG MINI LOZENGE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363098726","LABEL_NAME":"WAL-TAP DM COLD-COUGH ELIXIR","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363209208","LABEL_NAME":"CHILD WAL-ITIN 5 MG/5 ML SOLN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363237001","LABEL_NAME":"ULTRA THIN 30G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00363237102","LABEL_NAME":"MICRO THIN 33G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00372000604","LABEL_NAME":"SCOT-TUSSIN 100 MG/5 ML LIQ","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00378000532","LABEL_NAME":"EVEROLIMUS 2 MG TAB FOR SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378000632","LABEL_NAME":"EVEROLIMUS 3 MG TAB FOR SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378000732","LABEL_NAME":"EVEROLIMUS 5 MG TAB FOR SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378001801","LABEL_NAME":"METOPROLOL TARTRATE 25 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378003201","LABEL_NAME":"METOPROLOL TARTRATE 50 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378004201","LABEL_NAME":"PERPHEN-AMITRIP 4 MG-10 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378004701","LABEL_NAME":"METOPROLOL TARTRATE 100 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378007301","LABEL_NAME":"PERPHEN-AMITRIP 4 MG-50 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378008801","LABEL_NAME":"CARBIDOPA-LEVO ER 25-100 TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378009401","LABEL_NAME":"CARBIDOPA-LEVO ER 50-200 TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378013701","LABEL_NAME":"ALLOPURINOL 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378014491","LABEL_NAME":"TAMOXIFEN 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378015601","LABEL_NAME":"PROBENECID 500 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378018101","LABEL_NAME":"ALLOPURINOL 300 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378021101","LABEL_NAME":"CHLORDIAZEPO-AMITRIPTYL 5-12.5","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378021301","LABEL_NAME":"CHLORTHALIDONE 50 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378021401","LABEL_NAME":"HALOPERIDOL 2 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378022101","LABEL_NAME":"TIMOLOL MALEATE 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378022201","LABEL_NAME":"CHLORTHALIDONE 25 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378024301","LABEL_NAME":"SPIRONOLACTONE 50 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378025701","LABEL_NAME":"HALOPERIDOL 1 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378026591","LABEL_NAME":"DABIGATRAN ETEXILATE 75 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378026691","LABEL_NAME":"DABIGATRAN ETEXILATE 150 MG CP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378027493","LABEL_NAME":"TAMOXIFEN 20 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378027701","LABEL_NAME":"CHLORDIAZEPOX-AMITRIPTYL 10-25","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378032701","LABEL_NAME":"HALOPERIDOL 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378033001","LABEL_NAME":"PERPHEN-AMITRIP 2 MG-10 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378033401","LABEL_NAME":"HALOPERIDOL 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378033501","LABEL_NAME":"HALOPERIDOL 20 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378035101","LABEL_NAME":"HALOPERIDOL 0.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378040301","LABEL_NAME":"SPIRONOLACTONE-HCTZ 25-25 TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378042101","LABEL_NAME":"METHYLDOPA 500 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378042401","LABEL_NAME":"METOPROLOL-HCTZ 50-25 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378043305","LABEL_NAME":"BUPROPION HCL 75 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378043401","LABEL_NAME":"METOPROLOL-HCTZ 100-25 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378043501","LABEL_NAME":"BUPROPION HCL 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378043701","LABEL_NAME":"SPIRONOLACTONE 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378044201","LABEL_NAME":"PERPHEN-AMITRIP 2 MG-25 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378044501","LABEL_NAME":"METOPROLOL-HCTZ 100-50 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378047201","LABEL_NAME":"DIVALPROEX SOD ER 250 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378047301","LABEL_NAME":"DIVALPROEX SOD ER 500 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378057401","LABEL_NAME":"PERPHEN-AMITRIP 4 MG-25 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378061101","LABEL_NAME":"METHYLDOPA 250 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378061201","LABEL_NAME":"THIORIDAZINE 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378061401","LABEL_NAME":"THIORIDAZINE 25 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378061601","LABEL_NAME":"THIORIDAZINE 50 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378061801","LABEL_NAME":"THIORIDAZINE 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378072301","LABEL_NAME":"ENALAPRIL-HCTZ 10-25 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378073401","LABEL_NAME":"FLUOXETINE HCL 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378073501","LABEL_NAME":"FLUOXETINE HCL 20 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378082501","LABEL_NAME":"CLOZAPINE 25 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378086001","LABEL_NAME":"CLOZAPINE 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378087116","LABEL_NAME":"CLONIDINE 0.1 MG/DAY PATCH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378087216","LABEL_NAME":"CLONIDINE 0.2 MG/DAY PATCH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378087316","LABEL_NAME":"CLONIDINE 0.3 MG/DAY PATCH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378097201","LABEL_NAME":"CLOZAPINE 50 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378097301","LABEL_NAME":"CLOZAPINE 200 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378102577","LABEL_NAME":"DONEPEZIL HCL 23 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378104901","LABEL_NAME":"DOXEPIN 10 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378114501","LABEL_NAME":"BUSPIRONE HCL 7.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378119001","LABEL_NAME":"GUANFACINE 2 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378120178","LABEL_NAME":"SORAFENIB 200 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378157001","LABEL_NAME":"TERAZOSIN 10 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378166519","LABEL_NAME":"TIZANIDINE HCL 2 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378166619","LABEL_NAME":"TIZANIDINE HCL 4 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378166719","LABEL_NAME":"TIZANIDINE HCL 6 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378170405","LABEL_NAME":"PRAMIPEXOLE 0.125 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378170505","LABEL_NAME":"PRAMIPEXOLE 0.25 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378170705","LABEL_NAME":"PRAMIPEXOLE 0.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378171277","LABEL_NAME":"PRAMIPEXOLE 1.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378171377","LABEL_NAME":"PRAMIPEXOLE 0.75 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378172193","LABEL_NAME":"AMLODIPINE-VALSARTAN 5-160 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378172293","LABEL_NAME":"AMLODIPINE-VALSARTAN 10-160 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378172393","LABEL_NAME":"AMLODIPINE-VALSARTAN 5-320 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378172493","LABEL_NAME":"AMLODIPINE-VALSARTAN 10-320 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378180010","LABEL_NAME":"LEVOTHYROXINE 25 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378180310","LABEL_NAME":"LEVOTHYROXINE 50 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378180510","LABEL_NAME":"LEVOTHYROXINE 75 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378180710","LABEL_NAME":"LEVOTHYROXINE 88 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378180910","LABEL_NAME":"LEVOTHYROXINE 100 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378181110","LABEL_NAME":"LEVOTHYROXINE 112 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378181310","LABEL_NAME":"LEVOTHYROXINE 125 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378181510","LABEL_NAME":"LEVOTHYROXINE 150 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378181710","LABEL_NAME":"LEVOTHYROXINE 175 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378181910","LABEL_NAME":"LEVOTHYROXINE 200 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378182177","LABEL_NAME":"LEVOTHYROXINE 300 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378182310","LABEL_NAME":"LEVOTHYROXINE 137 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378193501","LABEL_NAME":"LENALIDOMIDE 2.5 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378193601","LABEL_NAME":"LENALIDOMIDE 5 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378193701","LABEL_NAME":"LENALIDOMIDE 10 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378194001","LABEL_NAME":"LENALIDOMIDE 25 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378194101","LABEL_NAME":"LENALIDOMIDE 15 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378194201","LABEL_NAME":"LENALIDOMIDE 20 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378204501","LABEL_NAME":"TACROLIMUS 0.5 MG CAPSULE (IR)","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378204601","LABEL_NAME":"TACROLIMUS 1 MG CAPSULE (IR)","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378204701","LABEL_NAME":"TACROLIMUS 5 MG CAPSULE (IR)","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378214601","LABEL_NAME":"SPIRONOLACTONE 25 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378221491","LABEL_NAME":"TICAGRELOR 60 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378221591","LABEL_NAME":"TICAGRELOR 90 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378226401","LABEL_NAME":"TERAZOSIN 2 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378226801","LABEL_NAME":"TERAZOSIN 5 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378235077","LABEL_NAME":"ESOMEPRAZOLE MAG DR 20 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378235177","LABEL_NAME":"ESOMEPRAZOLE MAG DR 40 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378240101","LABEL_NAME":"TRIFLUOPERAZINE 1 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378240201","LABEL_NAME":"TRIFLUOPERAZINE 2 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378240501","LABEL_NAME":"TRIFLUOPERAZINE 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378241001","LABEL_NAME":"TRIFLUOPERAZINE 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378251693","LABEL_NAME":"FLUCONAZOLE 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378292077","LABEL_NAME":"TELMISARTAN 20 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378292177","LABEL_NAME":"TELMISARTAN 40 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378292277","LABEL_NAME":"TELMISARTAN 80 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378306577","LABEL_NAME":"FENOFIBRATE 48 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378306605","LABEL_NAME":"FENOFIBRATE 145 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378312501","LABEL_NAME":"DOXEPIN 25 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378322477","LABEL_NAME":"CANDESARTAN CILEXETIL 4 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378322577","LABEL_NAME":"CANDESARTAN CILEXETIL 8 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378323177","LABEL_NAME":"CANDESARTAN CILEXETIL 16 MG TB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378323277","LABEL_NAME":"CANDESARTAN CILEXETIL 32 MG TB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378326632","LABEL_NAME":"ETOPOSIDE 50 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378334016","LABEL_NAME":"XULANE 150-35 MCG/DAY PATCH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378334916","LABEL_NAME":"ESTRADIOL 0.025 MG PATCH(1/WK)","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378335016","LABEL_NAME":"ESTRADIOL 0.05 MG PATCH (1/WK)","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378335116","LABEL_NAME":"ESTRADIOL 0.075 MG PATCH(1/WK)","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378335216","LABEL_NAME":"ESTRADIOL 0.1 MG PATCH (1/WK)","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378336016","LABEL_NAME":"ESTRADIOL 0.0375MG PATCH(1/WK)","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378336116","LABEL_NAME":"ESTRADIOL 0.06 MG PATCH (1/WK)","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378343193","LABEL_NAME":"ARMODAFINIL 50 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378343293","LABEL_NAME":"ARMODAFINIL 150 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378343393","LABEL_NAME":"ARMODAFINIL 250 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378351501","LABEL_NAME":"MIRTAZAPINE 15 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378352091","LABEL_NAME":"FOSAMPRENAVIR 700 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378353001","LABEL_NAME":"MIRTAZAPINE 30 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378354501","LABEL_NAME":"MIRTAZAPINE 45 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378363501","LABEL_NAME":"CETIRIZINE HCL 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00378363701","LABEL_NAME":"CETIRIZINE HCL 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00378385005","LABEL_NAME":"PHENYTOIN 50 MG TABLET CHEW","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378404177","LABEL_NAME":"LOSARTAN POTASSIUM 25 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378404277","LABEL_NAME":"LOSARTAN POTASSIUM 50 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378404393","LABEL_NAME":"LOSARTAN POTASSIUM 100 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378405091","LABEL_NAME":"NEVIRAPINE 200 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378410591","LABEL_NAME":"ABACAVIR 300 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378416001","LABEL_NAME":"ATOVAQUONE-PROGUANIL 62.5-25","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378416201","LABEL_NAME":"ATOVAQUONE-PROGUANIL 250-100","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378425001","LABEL_NAME":"DOXEPIN 50 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378427093","LABEL_NAME":"AMBRISENTAN 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378427193","LABEL_NAME":"AMBRISENTAN 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378427577","LABEL_NAME":"VALACYCLOVIR HCL 500 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378427677","LABEL_NAME":"VALACYCLOVIR HCL 1 GRAM TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378450093","LABEL_NAME":"BUDESONIDE ER 9 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378451093","LABEL_NAME":"AMLODIPINE-ATORVAST 2.5-10 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378451193","LABEL_NAME":"AMLODIPINE-ATORVAST 2.5-20 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378451293","LABEL_NAME":"AMLODIPINE-ATORVAST 2.5-40 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378451393","LABEL_NAME":"AMLODIPINE-ATORVAST 5-10 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378451493","LABEL_NAME":"AMLODIPINE-ATORVAST 5-20 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378451593","LABEL_NAME":"AMLODIPINE-ATORVAST 5-40 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378451693","LABEL_NAME":"AMLODIPINE-ATORVAST 5-80 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378451793","LABEL_NAME":"AMLODIPINE-ATORVAST 10-10 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378451893","LABEL_NAME":"AMLODIPINE-ATORVAST 10-20 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378451993","LABEL_NAME":"AMLODIPINE-ATORVAST 10-40 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378452093","LABEL_NAME":"AMLODIPINE-ATORVAST 10-80 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378454201","LABEL_NAME":"DEXTROAMP-AMPHETAM 7.5 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378454401","LABEL_NAME":"DEXTROAMP-AMPHETAM 12.5 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378456005","LABEL_NAME":"POTASSIUM CL ER 8 MEQ TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378456105","LABEL_NAME":"POTASSIUM CL ER 10 MEQ TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378459301","LABEL_NAME":"METOPROLOL TARTRATE 37.5 MG TB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378459401","LABEL_NAME":"METOPROLOL TARTRATE 75 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378459510","LABEL_NAME":"METOPROLOL SUCC ER 25 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378459610","LABEL_NAME":"METOPROLOL SUCC ER 50 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378459710","LABEL_NAME":"METOPROLOL SUCC ER 100 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378459805","LABEL_NAME":"METOPROLOL SUCC ER 200 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378461501","LABEL_NAME":"DOXYLAMINE-PYRIDOXINE 10-10 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378461916","LABEL_NAME":"ESTRADIOL 0.025 MG PATCH(2/WK)","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378462016","LABEL_NAME":"ESTRADIOL 0.0375MG PATCH(2/WK)","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378462116","LABEL_NAME":"ESTRADIOL 0.05 MG PATCH (2/WK)","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378462216","LABEL_NAME":"ESTRADIOL 0.075 MG PATCH(2/WK)","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378462316","LABEL_NAME":"ESTRADIOL 0.1 MG PATCH (2/WK)","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378479106","LABEL_NAME":"FLUOROURACIL 5% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378489093","LABEL_NAME":"NEVIRAPINE ER 400 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378505101","LABEL_NAME":"CARBIDOPA-LEVO 10-100 MG ODT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378505301","LABEL_NAME":"CARBIDOPA-LEVO 25-250 MG ODT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378508973","LABEL_NAME":"VARENICLINE 0.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378509073","LABEL_NAME":"VARENICLINE 1 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378509185","LABEL_NAME":"VARENICLINE STARTING MONTH BOX","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378512301","LABEL_NAME":"SOTALOL AF 80 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378512401","LABEL_NAME":"SOTALOL AF 120 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378512501","LABEL_NAME":"SOTALOL AF 160 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378514405","LABEL_NAME":"DONEPEZIL HCL 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378514505","LABEL_NAME":"DONEPEZIL HCL 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378518593","LABEL_NAME":"PRASUGREL 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378518693","LABEL_NAME":"PRASUGREL 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378527001","LABEL_NAME":"ESZOPICLONE 1 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378527101","LABEL_NAME":"ESZOPICLONE 2 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378527201","LABEL_NAME":"ESZOPICLONE 3 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378537501","LABEL_NAME":"DOXEPIN 75 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378542601","LABEL_NAME":"GABAPENTIN 100 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378542805","LABEL_NAME":"GABAPENTIN 400 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378543135","LABEL_NAME":"GATIFLOXACIN 0.5% EYE DROPS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378544093","LABEL_NAME":"EMTRICIT-RILP-TENOF 200-25-300","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378557305","LABEL_NAME":"MODAFINIL 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378557505","LABEL_NAME":"MODAFINIL 200 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378561505","LABEL_NAME":"LEVETIRACETAM 500 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378561705","LABEL_NAME":"LEVETIRACETAM 750 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378561991","LABEL_NAME":"LEVETIRACETAM 1,000 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378563059","LABEL_NAME":"SUMATRIPTAN SUCC 25 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378563159","LABEL_NAME":"SUMATRIPTAN SUCC 50 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378563259","LABEL_NAME":"SUMATRIPTAN SUCC 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378580793","LABEL_NAME":"VALSARTAN 40 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378581377","LABEL_NAME":"VALSARTAN 80 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378581477","LABEL_NAME":"VALSARTAN 160 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378581577","LABEL_NAME":"VALSARTAN 320 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378619593","LABEL_NAME":"CINACALCET HCL 90 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378619693","LABEL_NAME":"CINACALCET HCL 60 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378619793","LABEL_NAME":"CINACALCET HCL 30 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378623101","LABEL_NAME":"CITALOPRAM HBR 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378623201","LABEL_NAME":"CITALOPRAM HBR 20 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378623301","LABEL_NAME":"CITALOPRAM HBR 40 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378632001","LABEL_NAME":"VERAPAMIL ER 120 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378632177","LABEL_NAME":"VALSARTAN-HCTZ 80-12.5 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378632277","LABEL_NAME":"VALSARTAN-HCTZ 160-12.5 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378632377","LABEL_NAME":"VALSARTAN-HCTZ 160-25 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378632477","LABEL_NAME":"VALSARTAN-HCTZ 320-12.5 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378632577","LABEL_NAME":"VALSARTAN-HCTZ 320-25 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378633380","LABEL_NAME":"ACAMPROSATE CALC DR 333 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378638001","LABEL_NAME":"VERAPAMIL ER 180 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378641001","LABEL_NAME":"DOXEPIN 100 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378644001","LABEL_NAME":"VERAPAMIL ER 240 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378647016","LABEL_NAME":"SCOPOLAMINE 1 MG/3 DAY PATCH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378655053","LABEL_NAME":"LEVONOR-ETH ESTRAD 0.15-0.03","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378661185","LABEL_NAME":"AMNESTEEM 10 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378661285","LABEL_NAME":"AMNESTEEM 20 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378661385","LABEL_NAME":"AMNESTEEM 30 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378661485","LABEL_NAME":"AMNESTEEM 40 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378668877","LABEL_NAME":"PANTOPRAZOLE SOD DR 20 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378668910","LABEL_NAME":"PANTOPRAZOLE SOD DR 40 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378696032","LABEL_NAME":"GLATIRAMER 20 MG/ML SYRINGE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378696112","LABEL_NAME":"GLATIRAMER 40 MG/ML SYRINGE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378697032","LABEL_NAME":"TADALAFIL 2.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378698501","LABEL_NAME":"SODIUM CHLORIDE 0.9% INHAL VL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378699331","LABEL_NAME":"LEVALBUTEROL CONC 1.25 MG/0.5","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378699789","LABEL_NAME":"SODIUM CHLORIDE 3% VIAL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378699889","LABEL_NAME":"SODIUM CHLORIDE 10% VIAL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378700110","LABEL_NAME":"PAROXETINE HCL 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378700210","LABEL_NAME":"PAROXETINE HCL 20 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378700310","LABEL_NAME":"PAROXETINE HCL 30 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378700410","LABEL_NAME":"PAROXETINE HCL 40 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378700501","LABEL_NAME":"LOXAPINE 5 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378701001","LABEL_NAME":"LOXAPINE 10 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378701705","LABEL_NAME":"BICALUTAMIDE 50 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378702501","LABEL_NAME":"LOXAPINE 25 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378705001","LABEL_NAME":"LOXAPINE 50 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378705752","LABEL_NAME":"ALBUTEROL SUL 0.63 MG/3 ML SOL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378705852","LABEL_NAME":"ALBUTEROL SUL 1.25 MG/3 ML SOL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378709601","LABEL_NAME":"BROMOCRIPTINE 5 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378712477","LABEL_NAME":"OLMESARTAN MEDOXOMIL 40 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378715001","LABEL_NAME":"CELECOXIB 200 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378715505","LABEL_NAME":"BUDESONIDE DR 3 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378718505","LABEL_NAME":"METFORMIN HCL 500 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378718605","LABEL_NAME":"METFORMIN HCL 850 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378718705","LABEL_NAME":"METFORMIN HCL 1,000 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378727453","LABEL_NAME":"NORETHIN-EE 1.5-0.03 MG(21) TB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378728053","LABEL_NAME":"NORETHIND-ETH ESTRAD 1-0.02 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378728153","LABEL_NAME":"LEVONOR-ETH ESTRAD 0.15-0.03","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378728653","LABEL_NAME":"NORG-ETHIN ESTRA 0.25-0.035 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378728753","LABEL_NAME":"LEVONOR-ETH ESTRAD 0.1-0.02 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378728853","LABEL_NAME":"NORETH-EE-FE 1.5-0.03MG(21)-75","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378729189","LABEL_NAME":"NORETHINDRONE 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378729253","LABEL_NAME":"NORETHINDRONE 0.35 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378729353","LABEL_NAME":"NORG-EE 0.18-0.215-0.25/0.035","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378729553","LABEL_NAME":"ESTRADIOL-NORETH 1-0.5 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378729653","LABEL_NAME":"DESOGESTR-ETH ESTRAD ETH ESTRA","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378729953","LABEL_NAME":"DROSPIRENONE-EE 3-0.02 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378730053","LABEL_NAME":"DROSPIRENONE-EE 3-0.03 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378730653","LABEL_NAME":"ETHYNODIOL-ETH ESTRA 1MG-50MCG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378730753","LABEL_NAME":"ETHYNODIOL-ETH ESTRA 1MG-35MCG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378750232","LABEL_NAME":"BREYNA 80-4.5 MCG INHALER","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378750332","LABEL_NAME":"BREYNA 160-4.5 MCG INHALER","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378797031","LABEL_NAME":"IPRATROPIUM BR 0.02% SOLN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378800801","LABEL_NAME":"DIVALPROEX DR 125 MG CAP SPRNK","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378804321","LABEL_NAME":"CLOBAZAM 2.5 MG/ML SUSPENSION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378806790","LABEL_NAME":"GLUCAGON 1 MG EMERGENCY KIT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378808220","LABEL_NAME":"TRETINOIN 0.025% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378808320","LABEL_NAME":"TRETINOIN 0.05% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378808420","LABEL_NAME":"TRETINOIN 0.1% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378810593","LABEL_NAME":"GALANTAMINE ER 8 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378810693","LABEL_NAME":"GALANTAMINE ER 16 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378810793","LABEL_NAME":"GALANTAMINE ER 24 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378819015","LABEL_NAME":"CLOBETASOL 0.05% OINTMENT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378827031","LABEL_NAME":"ALBUTEROL SUL 2.5 MG/3 ML SOLN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378830001","LABEL_NAME":"CARBIDOPA-LEVODOPA 50 MG-ENTA","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378876058","LABEL_NAME":"CYCLOSPORINE 0.05% EYE EMULS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378876516","LABEL_NAME":"BUPRENORPHINE-NALOX 2-0.5MG FM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378876616","LABEL_NAME":"BUPRENORPHINE-NALOX 4-1MG FILM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378876716","LABEL_NAME":"BUPRENORPHINE-NALOX 8-2MG FILM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378876816","LABEL_NAME":"BUPRENORPHINE-NALOX 12-3MG FLM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378904001","LABEL_NAME":"CYSTAGON 50 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378904501","LABEL_NAME":"CYSTAGON 150 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378905516","LABEL_NAME":"LIDOCAINE 5% PATCH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378907016","LABEL_NAME":"RIVASTIGMINE 4.6 MG/24HR PATCH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378907116","LABEL_NAME":"RIVASTIGMINE 9.5 MG/24HR PATCH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378907216","LABEL_NAME":"RIVASTIGMINE 13.3 MG/24HR PTCH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378910216","LABEL_NAME":"NITROGLYCERIN 0.1 MG/HR PATCH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378910416","LABEL_NAME":"NITROGLYCERIN 0.2 MG/HR PATCH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378911216","LABEL_NAME":"NITROGLYCERIN 0.4 MG/HR PATCH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378911616","LABEL_NAME":"NITROGLYCERIN 0.6 MG/HR PATCH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378911916","LABEL_NAME":"FENTANYL 12 MCG/HR PATCH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378912116","LABEL_NAME":"FENTANYL 25 MCG/HR PATCH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378912216","LABEL_NAME":"FENTANYL 50 MCG/HR PATCH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378912316","LABEL_NAME":"FENTANYL 75 MCG/HR PATCH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378912416","LABEL_NAME":"FENTANYL 100 MCG/HR PATCH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378920535","LABEL_NAME":"SUCRALFATE 1 GM/10 ML SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378932032","LABEL_NAME":"WIXELA 100-50 INHUB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378932132","LABEL_NAME":"WIXELA 250-50 INHUB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378932232","LABEL_NAME":"WIXELA 500-50 INHUB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378965132","LABEL_NAME":"TRAVOPROST 0.004% EYE DROP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00378967130","LABEL_NAME":"IPRAT-ALBUT 0.5-3(2.5) MG/3 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00394085932","LABEL_NAME":"HYDROCORTISONE 1% LOTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00404071613","LABEL_NAME":"ACETAMINOPHEN 500 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00404719901","LABEL_NAME":"PROPARACAINE 0.5% EYE DROPS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00406012301","LABEL_NAME":"HYDROCODONE-ACETAMIN 5-325 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00406012401","LABEL_NAME":"HYDROCODONE-ACETAMIN 7.5-325","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00406012501","LABEL_NAME":"HYDROCODONE-ACETAMIN 10-325 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00406012701","LABEL_NAME":"METHYLPHENIDATE ER 27 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00406013601","LABEL_NAME":"METHYLPHENIDATE ER 36 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00406015401","LABEL_NAME":"METHYLPHENIDATE ER 54 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00406037601","LABEL_NAME":"HYDROCODONE-ACETAMIN 5-300 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00406037701","LABEL_NAME":"HYDROCODONE-ACETAMIN 7.5-300","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00406037801","LABEL_NAME":"HYDROCODONE-ACETAMIN 10-300 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00406048301","LABEL_NAME":"ACETAMINOPHEN-COD #2 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00406048401","LABEL_NAME":"ACETAMINOPHEN-COD #3 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00406048501","LABEL_NAME":"ACETAMINOPHEN-COD #4 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00406051201","LABEL_NAME":"OXYCODONE-ACETAMINOPHEN 5-325","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00406052201","LABEL_NAME":"OXYCODONE-ACETAMINOPHN 7.5-325","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00406052301","LABEL_NAME":"OXYCODONE-ACETAMINOPHEN 10-325","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00406052710","LABEL_NAME":"METHADOSE 10 MG/ML ORAL CONC","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00406055201","LABEL_NAME":"OXYCODONE HCL (IR) 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00406114201","LABEL_NAME":"METHYLPHENIDATE 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00406114401","LABEL_NAME":"METHYLPHENIDATE 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00406114601","LABEL_NAME":"METHYLPHENIDATE 20 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00406117001","LABEL_NAME":"NALTREXONE 50 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00406123601","LABEL_NAME":"DIPHENOXYLATE-ATROP 2.5-0.025","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00406144501","LABEL_NAME":"METHYLPHENIDATE ER 10 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00406147301","LABEL_NAME":"METHYLPHENIDATE ER 20 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00406324301","LABEL_NAME":"HYDROMORPHONE 2 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00406324401","LABEL_NAME":"HYDROMORPHONE 4 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00406324901","LABEL_NAME":"HYDROMORPHONE 8 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00406512401","LABEL_NAME":"LISDEXAMFETAMINE 10 MG TB CHEW","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00406512501","LABEL_NAME":"LISDEXAMFETAMINE 20 MG TB CHEW","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00406512601","LABEL_NAME":"LISDEXAMFETAMINE 30 MG TB CHEW","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00406512701","LABEL_NAME":"LISDEXAMFETAMINE 40 MG TB CHEW","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00406512801","LABEL_NAME":"LISDEXAMFETAMINE 50 MG TB CHEW","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00406512901","LABEL_NAME":"LISDEXAMFETAMINE 60 MG TB CHEW","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00406831501","LABEL_NAME":"MORPHINE SULF ER 15 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00406832001","LABEL_NAME":"MORPHINE SULF ER 200 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00406833001","LABEL_NAME":"MORPHINE SULF ER 30 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00406838001","LABEL_NAME":"MORPHINE SULF ER 60 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00406839001","LABEL_NAME":"MORPHINE SULF ER 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00406851001","LABEL_NAME":"OXYCODONE HCL (IR) 10 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00406851501","LABEL_NAME":"OXYCODONE HCL (IR) 15 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00406852001","LABEL_NAME":"OXYCODONE HCL (IR) 20 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00406853001","LABEL_NAME":"OXYCODONE HCL (IR) 30 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00406855730","LABEL_NAME":"OXYCODONE HCL 100 MG/5 ML CONC","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00406880601","LABEL_NAME":"CLOMIPRAMINE 25 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00406880701","LABEL_NAME":"CLOMIPRAMINE 50 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00406880801","LABEL_NAME":"CLOMIPRAMINE 75 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00406888501","LABEL_NAME":"DEXTROAMP-AMPHETAMIN 15 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00406895801","LABEL_NAME":"DEXTROAMPHETAMINE 5 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00406895901","LABEL_NAME":"DEXTROAMPHETAMINE 10 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00406896001","LABEL_NAME":"DEXTROAMPHETAMINE ER 5 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00406896101","LABEL_NAME":"DEXTROAMPHETAMINE ER 10 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00406896201","LABEL_NAME":"DEXTROAMPHETAMINE ER 15 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00409121501","LABEL_NAME":"NALOXONE 0.4 MG/ML VIAL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00409121901","LABEL_NAME":"NALOXONE 4 MG/10 ML VIAL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00409131611","LABEL_NAME":"HEPARIN SOD 5,000 UNIT/0.5 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00409140212","LABEL_NAME":"HEPARIN 5,000 UNIT/ML CARPUJCT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00409178203","LABEL_NAME":"NALOXONE 0.4 MG/ML CARPUJECT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00409272001","LABEL_NAME":"HEPARIN SOD 1,000 UNIT/ML VIAL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00409272002","LABEL_NAME":"HEPARIN 10,000 UNIT/10 ML VIAL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00409272003","LABEL_NAME":"HEPARIN 30,000 UNIT/30 ML VIAL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00409272101","LABEL_NAME":"HEPARIN SOD 10,000 UNIT/ML VL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00409272301","LABEL_NAME":"HEPARIN SOD 5,000 UNIT/ML VIAL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00409272302","LABEL_NAME":"HEPARIN 50,000 UNIT/10 ML VIAL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00409330703","LABEL_NAME":"ACETYLCYSTEINE 10% VIAL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00409330803","LABEL_NAME":"ACETYLCYSTEINE 20% VIAL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00409655701","LABEL_NAME":"TESTOSTERONE CYP 1,000 MG/10ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00430042014","LABEL_NAME":"LO LOESTRIN FE 1-10 TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00456120130","LABEL_NAME":"LINZESS 145 MCG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00456120230","LABEL_NAME":"LINZESS 290 MCG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00456120330","LABEL_NAME":"LINZESS 72 MCG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00469012599","LABEL_NAME":"XTANDI 40 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00469062599","LABEL_NAME":"XTANDI 40 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00469072560","LABEL_NAME":"XTANDI 80 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00469142590","LABEL_NAME":"XOSPATA 40 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00472001304","LABEL_NAME":"GRISEOFULVIN 125 MG/5 ML SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00472008216","LABEL_NAME":"ACYCLOVIR 200 MG/5 ML SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00472012645","LABEL_NAME":"ADAPALENE 0.3% GEL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00472016615","LABEL_NAME":"NYSTATIN 100,000 UNIT/GM OINT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00472040394","LABEL_NAME":"CLOBETASOL 0.05% SHAMPOO","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00472103016","LABEL_NAME":"HYDROMET 5 MG-1.5 MG/5 ML SOLN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00472173803","LABEL_NAME":"MICONAZOLE 3 200 MG VAG SUPP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00472199208","LABEL_NAME":"NITROFURANTOIN 25 MG/5 ML SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00480008305","LABEL_NAME":"AMLODIPINE BESYLATE 2.5 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00480012649","LABEL_NAME":"ICOSAPENT ETHYL 500 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00480123208","LABEL_NAME":"RISPERIDONE ER 25 MG VIAL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00480134208","LABEL_NAME":"RISPERIDONE ER 37.5 MG VIAL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00480145308","LABEL_NAME":"RISPERIDONE ER 50 MG VIAL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00480155408","LABEL_NAME":"RISPERIDONE ER 12.5 MG VIAL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00480230956","LABEL_NAME":"TADALAFIL 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00480259634","LABEL_NAME":"FIDAXOMICIN 200 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00480315656","LABEL_NAME":"TERIFLUNOMIDE 14 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00480315756","LABEL_NAME":"TERIFLUNOMIDE 7 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00480323751","LABEL_NAME":"LAPATINIB 250 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00480327356","LABEL_NAME":"ALVAIZ 9 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00480327456","LABEL_NAME":"ALVAIZ 18 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00480327556","LABEL_NAME":"ALVAIZ 36 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00480327656","LABEL_NAME":"ALVAIZ 54 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00480330901","LABEL_NAME":"THEOPHYLLINE ER 450 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00480331001","LABEL_NAME":"THEOPHYLLINE ER 300 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00480347224","LABEL_NAME":"AMETHYST 90-20 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00480347516","LABEL_NAME":"NORA-BE TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00480349316","LABEL_NAME":"CRYSELLE-28 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00480349505","LABEL_NAME":"GABAPENTIN 300 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00480352356","LABEL_NAME":"DASATINIB 80 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00480352456","LABEL_NAME":"DASATINIB 140 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00480361087","LABEL_NAME":"PIRFENIDONE 267 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00480361198","LABEL_NAME":"PIRFENIDONE 801 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00480372001","LABEL_NAME":"PYRIMETHAMINE 25 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00480400028","LABEL_NAME":"VESTURA 3 MG-0.02 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00480405356","LABEL_NAME":"GEFITINIB 250 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00480418489","LABEL_NAME":"PAZOPANIB HCL 200 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00480449056","LABEL_NAME":"TASIMELTEON 20 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00480510106","LABEL_NAME":"DASATINIB 20 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00480510206","LABEL_NAME":"DASATINIB 50 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00480510306","LABEL_NAME":"DASATINIB 70 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00480510456","LABEL_NAME":"DASATINIB 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00480701156","LABEL_NAME":"DEFERASIROX 125 MG TB FOR SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00480701256","LABEL_NAME":"DEFERASIROX 250 MG TB FOR SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00480701356","LABEL_NAME":"DEFERASIROX 500 MG TB FOR SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00480706256","LABEL_NAME":"PERAMPANEL 2 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00480706356","LABEL_NAME":"PERAMPANEL 4 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00480706556","LABEL_NAME":"PERAMPANEL 6 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00480706656","LABEL_NAME":"PERAMPANEL 8 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00480706756","LABEL_NAME":"PERAMPANEL 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00480706856","LABEL_NAME":"PERAMPANEL 12 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00480716710","LABEL_NAME":"AMLODIPINE BESYLATE 5 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00480716810","LABEL_NAME":"AMLODIPINE BESYLATE 10 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00480775080","LABEL_NAME":"MESALAMINE 800 MG DR TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00480782056","LABEL_NAME":"FINGOLIMOD 0.5 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00480924201","LABEL_NAME":"PROPYLTHIOURACIL 50 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00480925708","LABEL_NAME":"OCTREOTIDE ACET ER 10 MG IM VL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00480925908","LABEL_NAME":"OCTREOTIDE ACET ER 20 MG IM VL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00480926208","LABEL_NAME":"OCTREOTIDE ACET ER 30 MG IM VL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00480927706","LABEL_NAME":"ALYQ 20 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00485005708","LABEL_NAME":"ED-APAP 160 MG/5 ML LIQUID","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00485020404","LABEL_NAME":"RYNEX DM LIQUID","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00487900730","LABEL_NAME":"SODIUM CHLORIDE 7% VIAL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00487990130","LABEL_NAME":"ALBUTEROL 2.5 MG/0.5 ML SOL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00527123101","LABEL_NAME":"PRIMIDONE 250 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00527130101","LABEL_NAME":"PRIMIDONE 50 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00527131101","LABEL_NAME":"TERBUTALINE SULFATE 5 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00527132601","LABEL_NAME":"URSODIOL 300 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00527133301","LABEL_NAME":"BACLOFEN 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00527133501","LABEL_NAME":"DOXYCYCLINE MONO 50 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00527133825","LABEL_NAME":"DOXYCYCLINE MONO 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00527136801","LABEL_NAME":"DANAZOL 100 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00527136901","LABEL_NAME":"DANAZOL 200 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00527139201","LABEL_NAME":"DANAZOL 50 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00527143501","LABEL_NAME":"METAXALONE 800 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00527163201","LABEL_NAME":"TRIAMTERENE-HCTZ 37.5-25 MG CP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00527169501","LABEL_NAME":"BUTALB-ACETAMIN-CAFF 50-325-40","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00527178801","LABEL_NAME":"FLUPHENAZINE 1 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00527178901","LABEL_NAME":"FLUPHENAZINE 2.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00527179001","LABEL_NAME":"FLUPHENAZINE 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00527179101","LABEL_NAME":"FLUPHENAZINE 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00527181843","LABEL_NAME":"SUMATRIPTAN 5 MG NASAL SPRAY","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00527183037","LABEL_NAME":"ENTACAPONE 200 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00527185943","LABEL_NAME":"SUMATRIPTAN 20 MG NASAL SPRAY","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00527193006","LABEL_NAME":"CLARITHROMYCIN ER 500 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00527193106","LABEL_NAME":"CLARITHROMYCIN 250 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00527193206","LABEL_NAME":"CLARITHROMYCIN 500 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00527194866","LABEL_NAME":"LEVOFLOXACIN 25 MG/ML SOLUTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00527237020","LABEL_NAME":"AZITHROMYCIN 250 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00527239519","LABEL_NAME":"AZITHROMYCIN 500 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00527242532","LABEL_NAME":"OLMESARTAN MEDOXOMIL 5 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00527242632","LABEL_NAME":"OLMESARTAN MEDOXOMIL 20 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00527296137","LABEL_NAME":"CHLORPROMAZINE 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00527296237","LABEL_NAME":"CHLORPROMAZINE 25 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00527296337","LABEL_NAME":"CHLORPROMAZINE 50 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00527296437","LABEL_NAME":"CHLORPROMAZINE 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00527296537","LABEL_NAME":"CHLORPROMAZINE 200 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00527301248","LABEL_NAME":"MESALAMINE DR 1.2 GM TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00527457937","LABEL_NAME":"METHYLPHENIDATE CD 10 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00527458037","LABEL_NAME":"METHYLPHENIDATE CD 20 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00527458137","LABEL_NAME":"METHYLPHENIDATE CD 30 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00527458237","LABEL_NAME":"METHYLPHENIDATE CD 40 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00527458337","LABEL_NAME":"METHYLPHENIDATE CD 50 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00527458437","LABEL_NAME":"METHYLPHENIDATE CD 60 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00527459113","LABEL_NAME":"OSELTAMIVIR PHOS 30 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00527459213","LABEL_NAME":"OSELTAMIVIR PHOS 45 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00527459313","LABEL_NAME":"OSELTAMIVIR PHOS 75 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00527516082","LABEL_NAME":"MYCOPHENOLATE 200 MG/ML SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00527540668","LABEL_NAME":"PREDNISOLONE 15 MG/5 ML SYRUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00536105224","LABEL_NAME":"POLYETHYLENE GLYCOL 3350 POWD","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00536105227","LABEL_NAME":"POLYETHYLENE GLYCOL 3350 POWD","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00536105556","LABEL_NAME":"ACNE MEDICATION 5% GEL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00536105656","LABEL_NAME":"ACNE MEDICATION 10% GEL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00536118313","LABEL_NAME":"FLUTICASONE PROP 50 MCG SPRAY","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00536125628","LABEL_NAME":"BACITRACIN 500 UNIT/GM OINTMNT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00536126163","LABEL_NAME":"BENZOYL PEROXIDE 10% WASH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00536129229","LABEL_NAME":"ACETAMINOPHEN 500 MG GELCAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00536130723","LABEL_NAME":"OLOPATADINE HCL 0.2% EYE DROP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00536131108","LABEL_NAME":"CHEST CONGEST RLF 400 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00536132197","LABEL_NAME":"CHLD ACETAMINOPHEN 160 MG/5 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00536132701","LABEL_NAME":"ACETAMINOPHEN 325 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00536133835","LABEL_NAME":"NICOTINE 4 MG LOZENGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00536134380","LABEL_NAME":"VITAMIN D3 10 MCG/ML DROP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00536134480","LABEL_NAME":"INFANT IRON 15 MG/ML DROP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00536141220","LABEL_NAME":"ADAPALENE 0.1% GEL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00536141347","LABEL_NAME":"ACETAMINOPHEN 500 MG CAPLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00536142541","LABEL_NAME":"MICONAZOLE 3 COMBO PACK","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00536142677","LABEL_NAME":"INF ACETAMINOPHEN 160 MG/5 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00536143363","LABEL_NAME":"LEVONORGESTREL 1.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00536145684","LABEL_NAME":"BUDESONIDE 32 MCG NASAL SPRAY","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00536406301","LABEL_NAME":"CLASSIC PRENATAL TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00536408501","LABEL_NAME":"PRENATAL VITAMINS TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00536440601","LABEL_NAME":"VITAMIN B-6 25 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00548540000","LABEL_NAME":"MEDROXYPROGESTERONE 150 MG/ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00548560100","LABEL_NAME":"ENOXAPARIN 30 MG/0.3 ML SYR","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00548560200","LABEL_NAME":"ENOXAPARIN 40 MG/0.4 ML SYR","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00548560300","LABEL_NAME":"ENOXAPARIN 60 MG/0.6 ML SYR","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00548560400","LABEL_NAME":"ENOXAPARIN 80 MG/0.8 ML SYR","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00548560500","LABEL_NAME":"ENOXAPARIN 100 MG/ML SYRINGE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00548560600","LABEL_NAME":"ENOXAPARIN 120 MG/0.8 ML SYR","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00548560700","LABEL_NAME":"ENOXAPARIN 150 MG/ML SYRINGE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00548560800","LABEL_NAME":"ENOXAPARIN 300 MG/3 ML VIAL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00548570100","LABEL_NAME":"MEDROXYPROGESTERONE 150 MG/ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00548835101","LABEL_NAME":"BAQSIMI 3 MG SPRAY ONE PACK","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00548835202","LABEL_NAME":"BAQSIMI 3 MG SPRAY TWO PACK","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00555003302","LABEL_NAME":"CHLORDIAZEPOXIDE 10 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00555015802","LABEL_NAME":"CHLORDIAZEPOXIDE 5 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00555015902","LABEL_NAME":"CHLORDIAZEPOXIDE 25 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00555032402","LABEL_NAME":"HYDROXYZINE PAM 100 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00555048302","LABEL_NAME":"AMILORIDE HCL-HCTZ 5-50 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00555060602","LABEL_NAME":"MEGESTROL 20 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00555060702","LABEL_NAME":"MEGESTROL 40 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00555071102","LABEL_NAME":"TRAZODONE 300 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00555077902","LABEL_NAME":"MEDROXYPROGESTERONE 10 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00555087202","LABEL_NAME":"MEDROXYPROGESTERONE 2.5 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00555087302","LABEL_NAME":"MEDROXYPROGESTERONE 5 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00555088202","LABEL_NAME":"HYDROXYUREA 500 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00555088602","LABEL_NAME":"ESTRADIOL 1 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00555088702","LABEL_NAME":"ESTRADIOL 2 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00555089902","LABEL_NAME":"ESTRADIOL 0.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00555105456","LABEL_NAME":"CLARAVIS 10 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00555105556","LABEL_NAME":"CLARAVIS 20 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00555105660","LABEL_NAME":"CLARAVIS 30 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00555105756","LABEL_NAME":"CLARAVIS 40 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00555900867","LABEL_NAME":"NORTREL 0.5-35-28 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00555900942","LABEL_NAME":"NORTREL 1-35 21 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00555901058","LABEL_NAME":"NORTREL 1-35 28 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00555901258","LABEL_NAME":"NORTREL 7-7-7-28 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00555901467","LABEL_NAME":"LESSINA-28 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00555901658","LABEL_NAME":"SPRINTEC 28 DAY TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00555901858","LABEL_NAME":"TRI-SPRINTEC TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00555902058","LABEL_NAME":"PORTIA-28 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00555902542","LABEL_NAME":"JUNEL 1 MG-20 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00555902658","LABEL_NAME":"JUNEL FE 1 MG-20 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00555902742","LABEL_NAME":"JUNEL 1.5 MG-30 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00555902858","LABEL_NAME":"JUNEL FE 1.5 MG-30 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00555903270","LABEL_NAME":"TRI-LEGEST FE-28 DAY TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00555903458","LABEL_NAME":"BALZIVA 28 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00555904358","LABEL_NAME":"APRI 28 DAY TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00555904558","LABEL_NAME":"AVIANE-28 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00555904758","LABEL_NAME":"ENPRESSE-28 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00555905058","LABEL_NAME":"KARIVA 28 DAY TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00555905167","LABEL_NAME":"VELIVET 28 DAY TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00555906458","LABEL_NAME":"KELNOR 1-35 28 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00555906667","LABEL_NAME":"ARANELLE 28 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00555912366","LABEL_NAME":"JOLESSA 0.15 MG-0.03 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00574010601","LABEL_NAME":"BROMOCRIPTINE 2.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00574011501","LABEL_NAME":"FLAVOXATE HCL 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00574011830","LABEL_NAME":"TROSPIUM CHLORIDE ER 60 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00574014560","LABEL_NAME":"TROSPIUM CHLORIDE 20 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00574029201","LABEL_NAME":"AMILORIDE HCL 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00574029301","LABEL_NAME":"HYDROMORPHONE HCL ER 8 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00574029401","LABEL_NAME":"HYDROMORPHONE HCL ER 12 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00574029501","LABEL_NAME":"HYDROMORPHONE HCL ER 16 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00574061105","LABEL_NAME":"PODOFILOX 0.5% TOPICAL SOLN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00574079001","LABEL_NAME":"METHAZOLAMIDE 25 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00574079101","LABEL_NAME":"METHAZOLAMIDE 50 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00574200802","LABEL_NAME":"NYSTOP 100,000 UNIT/GM POWDER","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00574206101","LABEL_NAME":"CICLOPIROX 0.77% GEL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00574401210","LABEL_NAME":"BRINZOLAMIDE 1% EYE DROPS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00574402135","LABEL_NAME":"POLYCIN EYE OINTMENT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00574402235","LABEL_NAME":"BACITRACIN 500 UNIT/GM OPHTH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00574402411","LABEL_NAME":"ERYTHROMYCIN 0.5% EYE OINTMENT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00574403105","LABEL_NAME":"TOBRAMYCIN-DEXAMETH OPHTH SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00574413505","LABEL_NAME":"LOTEPREDNOL ETABONATE 0.5% DRP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00574414435","LABEL_NAME":"NEO-POLYCIN HC EYE OINTMENT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00574416035","LABEL_NAME":"NEOMYC-POLYM-DEXAMET EYE OINTM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00574419035","LABEL_NAME":"SULFACETAMIDE 10% EYE OINTMENT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00574425035","LABEL_NAME":"NEO-POLYCIN EYE OINTMENT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00574711012","LABEL_NAME":"MORPHINE SULF 5 MG SUPPOS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00574711212","LABEL_NAME":"MORPHINE SULF 10 MG SUPPOS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00574711412","LABEL_NAME":"MORPHINE SULF 20 MG SUPPOS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00574711612","LABEL_NAME":"MORPHINE SULF 30 MG SUPPOS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00574722406","LABEL_NAME":"HYDROMORPHONE 3 MG SUPPOS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00574722612","LABEL_NAME":"COMPRO 25 MG SUPPOSITORY","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591034301","LABEL_NAME":"VERAPAMIL 80 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591034501","LABEL_NAME":"VERAPAMIL 120 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591034701","LABEL_NAME":"HYDROCHLOROTHIAZIDE 12.5 MG CP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591034801","LABEL_NAME":"TRIAMTERENE-HCTZ 75-50 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591039501","LABEL_NAME":"PENTAZOCINE-NALOXONE TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591040401","LABEL_NAME":"VERAPAMIL 40 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591040501","LABEL_NAME":"LISINOPRIL 2.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591040601","LABEL_NAME":"LISINOPRIL 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591040701","LABEL_NAME":"LISINOPRIL 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591040801","LABEL_NAME":"LISINOPRIL 20 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591040901","LABEL_NAME":"LISINOPRIL 40 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591042401","LABEL_NAME":"TRIAMTERENE-HCTZ 37.5-25 MG TB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591044401","LABEL_NAME":"GUANFACINE 1 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591046001","LABEL_NAME":"GLIPIZIDE 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591046101","LABEL_NAME":"GLIPIZIDE 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591074401","LABEL_NAME":"ESTAZOLAM 1 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591074501","LABEL_NAME":"ESTAZOLAM 2 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591086001","LABEL_NAME":"LISINOPRIL-HCTZ 10-12.5 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591086101","LABEL_NAME":"LISINOPRIL-HCTZ 20-12.5 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591086201","LABEL_NAME":"LISINOPRIL-HCTZ 20-25 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591211481","LABEL_NAME":"TESTOSTERONE 30 MG/1.5 ML PUMP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591213155","LABEL_NAME":"AZELAIC ACID 15% GEL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591215990","LABEL_NAME":"CICLOPIROX 1% SHAMPOO","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591219101","LABEL_NAME":"RAMELTEON 8 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591236360","LABEL_NAME":"TESTOSTERONE 10 MG GEL PUMP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591247401","LABEL_NAME":"TETRACYCLINE 250 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591247501","LABEL_NAME":"TETRACYCLINE 500 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591251160","LABEL_NAME":"BOSENTAN 62.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591251260","LABEL_NAME":"BOSENTAN 125 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591252001","LABEL_NAME":"CHLORZOXAZONE 500 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591253360","LABEL_NAME":"DALFAMPRIDINE ER 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591257920","LABEL_NAME":"VALGANCICLOVIR HCL 50 MG/ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591268201","LABEL_NAME":"POTASSIUM CITRATE ER 5 MEQ TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591271202","LABEL_NAME":"ALBENDAZOLE 200 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591272901","LABEL_NAME":"POTASSIUM CITRATE ER 10 MEQ TB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591274201","LABEL_NAME":"POTASSIUM CITRATE ER 15 MEQ TB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591292102","LABEL_NAME":"TESTOSTERONE 12.5 MG/1.25 GRAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591292418","LABEL_NAME":"TESTOSTERONE 1.62% GEL PUMP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591292625","LABEL_NAME":"TESTOSTERONE 1.62% (2.5 G) PKT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591294430","LABEL_NAME":"PIMECROLIMUS 1% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591313760","LABEL_NAME":"NIZATIDINE 150 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591313830","LABEL_NAME":"NIZATIDINE 300 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591321617","LABEL_NAME":"TESTOSTERONE 1% (25MG/2.5G) PK","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591321726","LABEL_NAME":"TESTOSTERONE 1% (50 MG/5 G) PK","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591333105","LABEL_NAME":"BUPROPION HCL XL 150 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591335501","LABEL_NAME":"NATEGLINIDE 120 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591352426","LABEL_NAME":"TESTOSTERONE 50 MG/5 GRAM GEL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591354005","LABEL_NAME":"BUPROPION HCL SR 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591354105","LABEL_NAME":"BUPROPION HCL SR 150 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591354260","LABEL_NAME":"BUPROPION HCL SR 200 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591354360","LABEL_NAME":"BUPROPION HCL SR 150 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591367001","LABEL_NAME":"NABUMETONE 500 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591367101","LABEL_NAME":"NABUMETONE 750 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591372030","LABEL_NAME":"TRANEXAMIC ACID 650 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591379519","LABEL_NAME":"SOLIFENACIN 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591379619","LABEL_NAME":"SOLIFENACIN 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591387044","LABEL_NAME":"MEMANTINE HCL 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591387544","LABEL_NAME":"MEMANTINE HCL 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591390087","LABEL_NAME":"MEMANTINE 5-10 MG TITRATION PK","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591398260","LABEL_NAME":"CELECOXIB 50 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591398301","LABEL_NAME":"CELECOXIB 100 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591398560","LABEL_NAME":"CELECOXIB 400 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591401201","LABEL_NAME":"VALPROIC ACID 250 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591405094","LABEL_NAME":"SILDENAFIL 10 MG/ML ORAL SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591405289","LABEL_NAME":"IVERMECTIN 1% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591410101","LABEL_NAME":"PERPHENAZINE 2 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591410201","LABEL_NAME":"PERPHENAZINE 4 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591410301","LABEL_NAME":"PERPHENAZINE 8 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591410401","LABEL_NAME":"PERPHENAZINE 16 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591417101","LABEL_NAME":"PENICILLAMINE 250 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591439096","LABEL_NAME":"MIFEPRISTONE 300 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591505221","LABEL_NAME":"PREDNISONE 5 MG TAB DOSE PACK","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591530701","LABEL_NAME":"PROMETHAZINE 25 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591531901","LABEL_NAME":"PROMETHAZINE 50 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591533501","LABEL_NAME":"TRIHEXYPHENIDYL 2 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591533701","LABEL_NAME":"TRIHEXYPHENIDYL 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591544221","LABEL_NAME":"PREDNISONE 10 MG TAB DOSE PACK","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591559001","LABEL_NAME":"TRANYLCYPROMINE SULF 10 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591564201","LABEL_NAME":"MINOXIDIL 2.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591564301","LABEL_NAME":"MINOXIDIL 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591566001","LABEL_NAME":"SULINDAC 200 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591566101","LABEL_NAME":"SULINDAC 150 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591569401","LABEL_NAME":"MINOCYCLINE 50 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591569550","LABEL_NAME":"MINOCYCLINE 100 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591571301","LABEL_NAME":"AMOXAPINE 25 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591571401","LABEL_NAME":"AMOXAPINE 50 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591571501","LABEL_NAME":"AMOXAPINE 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591571630","LABEL_NAME":"AMOXAPINE 150 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591578201","LABEL_NAME":"ATENOLOL-CHLORTHALIDONE 50-25","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00591578301","LABEL_NAME":"ATENOLOL-CHLORTHALIDONE 100-25","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00597000302","LABEL_NAME":"APTIVUS 250 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00597002402","LABEL_NAME":"COMBIVENT RESPIMAT 20-100 MCG","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00597008717","LABEL_NAME":"ATROVENT 17 MCG HFA INHALER","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00597010051","LABEL_NAME":"SPIRIVA RESPIMAT 2.5 MCG INH","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00597013730","LABEL_NAME":"GILOTRIF 30 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00597013830","LABEL_NAME":"GILOTRIF 40 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00597014030","LABEL_NAME":"TRADJENTA 5 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00597014130","LABEL_NAME":"GILOTRIF 20 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00597014360","LABEL_NAME":"OFEV 100 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00597014560","LABEL_NAME":"OFEV 150 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00597014618","LABEL_NAME":"JENTADUETO 2.5 MG-500 MG TAB","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00597014718","LABEL_NAME":"JENTADUETO 2.5 MG-850 MG TAB","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00597014818","LABEL_NAME":"JENTADUETO 2.5 MG-1000 MG TAB","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00597015230","LABEL_NAME":"JARDIANCE 10 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00597015330","LABEL_NAME":"JARDIANCE 25 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00597015561","LABEL_NAME":"STIOLTO RESPIMAT INHALER (60)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00597015570","LABEL_NAME":"STIOLTO RESPIMAT INHALER (10)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00597015918","LABEL_NAME":"SYNJARDY 5-500 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00597016061","LABEL_NAME":"SPIRIVA RESPIMAT 1.25 MCG INH","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00597016430","LABEL_NAME":"GLYXAMBI 25 MG-5 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00597016818","LABEL_NAME":"SYNJARDY 12.5-1,000 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00597017518","LABEL_NAME":"SYNJARDY 5-1,000 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00597018018","LABEL_NAME":"SYNJARDY 12.5-500 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00597018230","LABEL_NAME":"GLYXAMBI 10 MG-5 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00597019261","LABEL_NAME":"STRIVERDI RESPIMAT INHAL SPRAY","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00597027073","LABEL_NAME":"JENTADUETO XR 2.5 MG-1,000 MG","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00597027533","LABEL_NAME":"JENTADUETO XR 5 MG-1,000 MG TB","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00597028073","LABEL_NAME":"SYNJARDY XR 10-1,000 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00597029059","LABEL_NAME":"SYNJARDY XR 5-1,000 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00597029578","LABEL_NAME":"SYNJARDY XR 25-1,000 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00597030045","LABEL_NAME":"SYNJARDY XR 12.5-1,000 MG TAB","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00597038013","LABEL_NAME":"TRIJARDY XR 10-5-1,000 MG TAB","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00597038577","LABEL_NAME":"TRIJARDY XR 12.5-2.5-1,000 MG","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00597039013","LABEL_NAME":"TRIJARDY XR 25-5-1,000 MG TAB","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00597039523","LABEL_NAME":"TRIJARDY XR 5-2.5-1,000 MG TAB","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00597054522","LABEL_NAME":"ADALIMUMAB-ADBM(CF) PEN 40 MG","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00597055580","LABEL_NAME":"ADALIMUMAB-ADBM(CF) 20 MG SYRG","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00597056520","LABEL_NAME":"ADALIMUMAB-ADBM(CF) 40 MG SYRG","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00597057550","LABEL_NAME":"ADALIMUMAB-ADBM(CF) PEN 40 MG","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00597058589","LABEL_NAME":"ADALIMUMAB-ADBM(CF) 10 MG SYRG","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00597059520","LABEL_NAME":"ADALIMUMAB-ADBM(CF) 40 MG SYRG","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00597062010","LABEL_NAME":"SPEVIGO 150 MG/ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00597246541","LABEL_NAME":"JASCAYD 9 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00597731321","LABEL_NAME":"JASCAYD 18 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00597770541","LABEL_NAME":"SPEVIGO 300 MG/2 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00597925759","LABEL_NAME":"HERNEXEOS 60 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00603243321","LABEL_NAME":"BENZTROPINE MES 0.5 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00603243421","LABEL_NAME":"BENZTROPINE MES 1 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00603243521","LABEL_NAME":"BENZTROPINE MES 2 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00603254021","LABEL_NAME":"BUTALBITAL-ACETAMINOPHN 50-325","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00603358121","LABEL_NAME":"FELODIPINE ER 2.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00603358221","LABEL_NAME":"FELODIPINE ER 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00603358321","LABEL_NAME":"FELODIPINE ER 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00603459315","LABEL_NAME":"METHYLPREDNISOLONE 4 MG DOSEPK","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00603459321","LABEL_NAME":"METHYLPREDNISOLONE 4 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00603516521","LABEL_NAME":"PHENOBARBITAL 16.2 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00603516621","LABEL_NAME":"PHENOBARBITAL 32.4 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00603516721","LABEL_NAME":"PHENOBARBITAL 64.8 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00603516821","LABEL_NAME":"PHENOBARBITAL 97.2 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00603533521","LABEL_NAME":"PREDNISONE 1 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00603533621","LABEL_NAME":"PREDNISONE 2.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00641616601","LABEL_NAME":"AMIKACIN SULF 1 GRAM/4 ML VIAL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00641616701","LABEL_NAME":"AMIKACIN SULF 500 MG/2 ML VIAL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00641617401","LABEL_NAME":"OCTREOTIDE ACET 50 MCG/ML VIAL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00641617501","LABEL_NAME":"OCTREOTIDE ACET 100 MCG/ML VL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00641617601","LABEL_NAME":"OCTREOTIDE ACET 500 MCG/ML VL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00641617701","LABEL_NAME":"OCTREOTIDE 1,000 MCG/5 ML VIAL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00641617801","LABEL_NAME":"OCTREOTIDE 5,000 MCG/5 ML VIAL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00641619301","LABEL_NAME":"NALOXONE 0.4 MG/ML SYRINGE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00641620501","LABEL_NAME":"NALOXONE 2 MG/2 ML SYRINGE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00642746312","LABEL_NAME":"BENZNIDAZOLE 12.5 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00642746410","LABEL_NAME":"BENZNIDAZOLE 100 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00642746605","LABEL_NAME":"NUVESSA VAGINAL 1.3% GEL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00703367501","LABEL_NAME":"METHOTREXATE 250 MG/10 ML VIAL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00703367801","LABEL_NAME":"METHOTREXATE 1 GRAM/40 ML VIAL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00713013206","LABEL_NAME":"PROMETHEGAN 50 MG SUPPOSITORY","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00713013506","LABEL_NAME":"PROCHLORPERAZINE 25 MG SUPP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00713022315","LABEL_NAME":"FLUOCINOLONE 0.01% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00713031853","LABEL_NAME":"CALCIPOTRIENE 0.005% SOLUTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00713035281","LABEL_NAME":"BETAINE 1 GRAM/SCOOP POWDER","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00713052612","LABEL_NAME":"PROMETHEGAN 25 MG SUPPOSITORY","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00713053606","LABEL_NAME":"PROMETHEGAN 12.5 MG SUPPOS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00713055273","LABEL_NAME":"TERCONAZOLE 80 MG SUPPOSITORY","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00713057460","LABEL_NAME":"METRONIDAZOLE TOPICAL 1% GEL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00713057571","LABEL_NAME":"METRONIDAZOLE VAGINAL 0.75% GL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00713059204","LABEL_NAME":"KETOCONAZOLE 2% SHAMPOO","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00713063115","LABEL_NAME":"FLUTICASONE PROP 0.05% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00713063215","LABEL_NAME":"FLUTICASONE PROP 0.005% OINT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00713063415","LABEL_NAME":"MOMETASONE FUROATE 0.1% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00713063515","LABEL_NAME":"MOMETASONE FUROATE 0.1% OINT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00713063737","LABEL_NAME":"METRONIDAZOLE TOPICAL 0.75% GL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00713063815","LABEL_NAME":"CICLOPIROX 0.77% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00713064015","LABEL_NAME":"HALOBETASOL PROP 0.05% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00713065540","LABEL_NAME":"TRIAMCINOLONE 0.1% PASTE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00713066115","LABEL_NAME":"DESONIDE 0.05% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00713067031","LABEL_NAME":"TAZAROTENE 0.1% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00713067653","LABEL_NAME":"TRIAMCINOLONE 0.1% LOTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00713067815","LABEL_NAME":"NYSTATIN 100,000 UNIT/GM CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00713068215","LABEL_NAME":"GENTAMICIN 0.1% OINTMENT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00713068315","LABEL_NAME":"GENTAMICIN 0.1% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00713070915","LABEL_NAME":"FLUOCINOLONE 0.025% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00713072015","LABEL_NAME":"HYDROCORTISONE VAL 0.2% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00713082375","LABEL_NAME":"PROMETHAZINE-CODEINE SOLUTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00713084909","LABEL_NAME":"HYDROCORTISONE-ACETIC EAR DROP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00713085109","LABEL_NAME":"CIPROFLOXACIN-HYDROCORT 0.2-1%","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00713088618","LABEL_NAME":"DAPSONE 5% GEL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00713093681","LABEL_NAME":"COLESEVELAM 625 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00761043620","LABEL_NAME":"VITAMIN B-6 50 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00761083920","LABEL_NAME":"SUPER B-50 COMPLEX CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00761087840","LABEL_NAME":"FOLIC ACID 400 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00766776052","LABEL_NAME":"NICORETTE 4 MG CHEWING GUM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00781148601","LABEL_NAME":"AMITRIPTYLINE HCL 10 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00781148701","LABEL_NAME":"AMITRIPTYLINE HCL 25 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00781148801","LABEL_NAME":"AMITRIPTYLINE HCL 50 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00781148901","LABEL_NAME":"AMITRIPTYLINE HCL 75 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00781149001","LABEL_NAME":"AMITRIPTYLINE HCL 100 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00781149101","LABEL_NAME":"AMITRIPTYLINE HCL 150 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00781187431","LABEL_NAME":"AMOX-CLAV 250-125 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00781194339","LABEL_NAME":"AMOX-CLAV ER 1,000-62.5 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00781214501","LABEL_NAME":"AMPICILLIN 500 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00781215832","LABEL_NAME":"PIRFENIDONE 267 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00781223401","LABEL_NAME":"OMEPRAZOLE DR 40 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00781227001","LABEL_NAME":"BUTALBITAL-ASPIRIN-CAFFEINE CP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00781232106","LABEL_NAME":"APREPITANT 40 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00781232246","LABEL_NAME":"APREPITANT 80 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00781232306","LABEL_NAME":"APREPITANT 125 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00781238301","LABEL_NAME":"METHYLPHENIDATE ER(LA) 10MG CP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00781285901","LABEL_NAME":"OMEPRAZOLE DR 10 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00781286801","LABEL_NAME":"OMEPRAZOLE DR 20 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00781300107","LABEL_NAME":"OMNITROPE 5 MG/1.5 ML CRTG","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00781300407","LABEL_NAME":"OMNITROPE 10 MG/1.5 ML CRTG","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00781323434","LABEL_NAME":"GLATOPA 20 MG/ML SYRINGE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00781325071","LABEL_NAME":"GLATOPA 40 MG/ML SYRINGE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00781344395","LABEL_NAME":"FONDAPARINUX 2.5 MG/0.5 ML SYR","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00781345495","LABEL_NAME":"FONDAPARINUX 5 MG/0.4 ML SYR","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00781346595","LABEL_NAME":"FONDAPARINUX 7.5 MG/0.6 ML SYR","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00781347695","LABEL_NAME":"FONDAPARINUX 10 MG/0.8 ML SYR","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00781400436","LABEL_NAME":"OMNITROPE 5.8 MG VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00781406336","LABEL_NAME":"APREPITANT 125-80-80 MG PACK","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00781531701","LABEL_NAME":"ZOLPIDEM TARTRATE 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00781531801","LABEL_NAME":"ZOLPIDEM TARTRATE 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00781543820","LABEL_NAME":"CEFPODOXIME 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00781543901","LABEL_NAME":"CEFPODOXIME 200 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00781551501","LABEL_NAME":"GRISEOFULVIN MICRO 500 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00781562501","LABEL_NAME":"CARBIDOPA-LEVODOPA 75 MG-ENTA","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00781563701","LABEL_NAME":"CARBIDOPA-LEVODOPA 100 MG-ENTA","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00781564101","LABEL_NAME":"CARBIDOPA-LEVODOPA 125 MG-ENTA","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00781565401","LABEL_NAME":"CARBIDOPA-LEVODOPA 150 MG-ENTA","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00781566731","LABEL_NAME":"VORICONAZOLE 50 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00781566831","LABEL_NAME":"VORICONAZOLE 200 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00781566901","LABEL_NAME":"CARBIDOPA-LEVODOPA 200 MG-ENTA","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00781602246","LABEL_NAME":"CLARITHROMYCIN 125 MG/5 ML SUS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00781602346","LABEL_NAME":"CLARITHROMYCIN 250 MG/5 ML SUS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00781618667","LABEL_NAME":"CIPROFLOX-DEXAMETH OTIC SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00781713593","LABEL_NAME":"MOXIFLOXACIN 0.5% EYE DROPS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00781718670","LABEL_NAME":"BRIMONIDINE-TIMOLOL 0.2%-0.5%","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00781804531","LABEL_NAME":"ARMODAFINIL 200 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00781809131","LABEL_NAME":"AZITHROMYCIN 600 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00832003800","LABEL_NAME":"OXYBUTYNIN 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00832046515","LABEL_NAME":"NYAMYC 100,000 UNIT/GM POWDER","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00832051000","LABEL_NAME":"BETHANECHOL 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00832051100","LABEL_NAME":"BETHANECHOL 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00832051200","LABEL_NAME":"BETHANECHOL 25 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00832051300","LABEL_NAME":"BETHANECHOL 50 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00832058011","LABEL_NAME":"CLOBAZAM 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00832058111","LABEL_NAME":"CLOBAZAM 20 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00832081411","LABEL_NAME":"DEFLAZACORT 6 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00832081530","LABEL_NAME":"DEFLAZACORT 18 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00832081630","LABEL_NAME":"DEFLAZACORT 30 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00832081730","LABEL_NAME":"DEFLAZACORT 36 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00832112035","LABEL_NAME":"TESTOSTERONE 50 MG/5 GRAM PKT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00832121100","LABEL_NAME":"JANTOVEN 1 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00832121200","LABEL_NAME":"JANTOVEN 2 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00832121300","LABEL_NAME":"JANTOVEN 2.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00832121400","LABEL_NAME":"JANTOVEN 3 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00832121500","LABEL_NAME":"JANTOVEN 4 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00832121600","LABEL_NAME":"JANTOVEN 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00832121700","LABEL_NAME":"JANTOVEN 6 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00832121800","LABEL_NAME":"JANTOVEN 7.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00832121900","LABEL_NAME":"JANTOVEN 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00832532410","LABEL_NAME":"POTASSIUM CL ER 10 MEQ TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00832532510","LABEL_NAME":"POTASSIUM CL ER 20 MEQ TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00832602211","LABEL_NAME":"CARBAMAZEPINE ER 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00832602311","LABEL_NAME":"CARBAMAZEPINE ER 200 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00832602411","LABEL_NAME":"CARBAMAZEPINE ER 400 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00832603212","LABEL_NAME":"FLUOXETINE 20 MG/5 ML SOLUTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00832604510","LABEL_NAME":"FAMOTIDINE 40 MG/5 ML SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00832607211","LABEL_NAME":"METHIMAZOLE 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00832607311","LABEL_NAME":"METHIMAZOLE 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00832608050","LABEL_NAME":"OLANZAPINE 7.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00869016638","LABEL_NAME":"CITROMA SOLUTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00904198760","LABEL_NAME":"MAPAP 500 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00904385461","LABEL_NAME":"CARBAMAZEPINE 100 MG TAB CHEW","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904531360","LABEL_NAME":"PRENATAL VITAMIN TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00904544861","LABEL_NAME":"PENTOXIFYLLINE ER 400 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904546335","LABEL_NAME":"INFANT IBUPROFEN 50 MG/1.25 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00904584709","LABEL_NAME":"MAPAP 500 MG/15 ML LIQUID","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00904585340","LABEL_NAME":"IBUPROFEN 400 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904585461","LABEL_NAME":"IBUPROFEN 600 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904585540","LABEL_NAME":"IBUPROFEN 800 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904589161","LABEL_NAME":"PRAVASTATIN SODIUM 10 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904589261","LABEL_NAME":"PRAVASTATIN SODIUM 20 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904589361","LABEL_NAME":"PRAVASTATIN SODIUM 40 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904595961","LABEL_NAME":"CLINDAMYCIN HCL 150 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904598348","LABEL_NAME":"AMMONIUM LACTATE 12% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00904598426","LABEL_NAME":"AMMONIUM LACTATE 12% LOTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00904617250","LABEL_NAME":"CARBAMAZEPINE 200 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904626908","LABEL_NAME":"ZIPRASIDONE HCL 20 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904627008","LABEL_NAME":"ZIPRASIDONE HCL 40 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904627108","LABEL_NAME":"ZIPRASIDONE HCL 60 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904627208","LABEL_NAME":"ZIPRASIDONE HCL 80 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904628661","LABEL_NAME":"OLANZAPINE 15 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904628761","LABEL_NAME":"OLANZAPINE 20 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904635161","LABEL_NAME":"LEVOFLOXACIN 250 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904635261","LABEL_NAME":"LEVOFLOXACIN 500 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904635361","LABEL_NAME":"LEVOFLOXACIN 750 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904637361","LABEL_NAME":"ROPINIROLE HCL 0.25 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904637461","LABEL_NAME":"ROPINIROLE HCL 1 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904637661","LABEL_NAME":"OLANZAPINE 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904637761","LABEL_NAME":"OLANZAPINE 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904641861","LABEL_NAME":"TIZANIDINE HCL 4 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904642661","LABEL_NAME":"ESCITALOPRAM 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904642761","LABEL_NAME":"ESCITALOPRAM 20 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904644961","LABEL_NAME":"ISOSORBIDE MONONIT ER 30 MG TB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904645061","LABEL_NAME":"ISOSORBIDE MONONIT ER 60 MG TB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904646707","LABEL_NAME":"CLOPIDOGREL 300 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904650106","LABEL_NAME":"FLUCONAZOLE 200 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904655161","LABEL_NAME":"ONDANSETRON HCL 4 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904655261","LABEL_NAME":"ONDANSETRON HCL 8 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904655304","LABEL_NAME":"LINEZOLID 600 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904656460","LABEL_NAME":"BENZONATATE 100 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904657004","LABEL_NAME":"OXYBUTYNIN CL ER 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904658304","LABEL_NAME":"LAMIVUDINE 150 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904664524","LABEL_NAME":"CHILD'S MAPAP 160 MG TAB CHEW","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00904665640","LABEL_NAME":"ARIPIPRAZOLE 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904666361","LABEL_NAME":"ACETAZOLAMIDE 250 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904667104","LABEL_NAME":"SILDENAFIL 20 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904670961","LABEL_NAME":"GLYCOPYRROLATE 1 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904673461","LABEL_NAME":"MEMANTINE HCL ER 7 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904676520","LABEL_NAME":"CHILD CETIRIZINE HCL 1 MG/ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00904676720","LABEL_NAME":"CHILD LORATADINE 5 MG/5 ML SOL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00904678504","LABEL_NAME":"MYCOPHENOLIC ACID DR 180 MG TB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904678604","LABEL_NAME":"MYCOPHENOLIC ACID DR 360 MG TB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904679604","LABEL_NAME":"VALGANCICLOVIR 450 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904680161","LABEL_NAME":"QUETIAPINE ER 50 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904680261","LABEL_NAME":"QUETIAPINE ER 150 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904680361","LABEL_NAME":"QUETIAPINE ER 200 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904680461","LABEL_NAME":"QUETIAPINE ER 300 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904680561","LABEL_NAME":"QUETIAPINE ER 400 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904680806","LABEL_NAME":"MONTELUKAST SOD 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904682104","LABEL_NAME":"TENOFOVIR DISOP FUM 300 MG TB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904682361","LABEL_NAME":"GABAPENTIN 600 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904683006","LABEL_NAME":"FINASTERIDE 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904683407","LABEL_NAME":"FLUCYTOSINE 250 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904683507","LABEL_NAME":"FLUCYTOSINE 500 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904686061","LABEL_NAME":"DIVALPROEX SOD DR 250 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904686161","LABEL_NAME":"DIVALPROEX SOD DR 500 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904686704","LABEL_NAME":"TRETINOIN 10 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904686861","LABEL_NAME":"TRAZODONE 50 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904686961","LABEL_NAME":"TRAZODONE 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904688210","LABEL_NAME":"PHYTONADIONE 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904688504","LABEL_NAME":"CARBAMAZEPINE ER 200 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904689004","LABEL_NAME":"URSODIOL 250 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904692461","LABEL_NAME":"SERTRALINE HCL 25 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904692561","LABEL_NAME":"SERTRALINE HCL 50 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904692661","LABEL_NAME":"SERTRALINE HCL 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904692861","LABEL_NAME":"TOPIRAMATE 25 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904692961","LABEL_NAME":"TOPIRAMATE 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904693126","LABEL_NAME":"POLYETHYLENE GLYCOL 3350 POWD","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00904693561","LABEL_NAME":"PALIPERIDONE ER 3 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904693661","LABEL_NAME":"PALIPERIDONE ER 6 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904693761","LABEL_NAME":"PALIPERIDONE ER 9 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904699104","LABEL_NAME":"PREGABALIN 25 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904699261","LABEL_NAME":"PREGABALIN 50 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904700061","LABEL_NAME":"PREGABALIN 75 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904700161","LABEL_NAME":"PREGABALIN 100 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904700261","LABEL_NAME":"PREGABALIN 150 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904700304","LABEL_NAME":"PREGABALIN 200 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904700404","LABEL_NAME":"PREGABALIN 225 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904700504","LABEL_NAME":"PREGABALIN 300 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904700761","LABEL_NAME":"LAMOTRIGINE 25 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904700861","LABEL_NAME":"LAMOTRIGINE 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904701416","LABEL_NAME":"CHLD ACETAMINOPHEN 160 MG/5 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00904704206","LABEL_NAME":"AMANTADINE 100 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904705699","LABEL_NAME":"ASPIRIN-DIPYRIDAM ER 25-200 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904705761","LABEL_NAME":"METHOCARBAMOL 500 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904705861","LABEL_NAME":"METHOCARBAMOL 750 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904708106","LABEL_NAME":"NIFEDIPINE ER 60 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904708204","LABEL_NAME":"NIFEDIPINE ER 90 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904710310","LABEL_NAME":"EZETIMIBE 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904710761","LABEL_NAME":"RIVASTIGMINE 1.5 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904710861","LABEL_NAME":"GABAPENTIN 800 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904712004","LABEL_NAME":"COLCHICINE 0.6 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904712361","LABEL_NAME":"LEVETIRACETAM 250 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904712661","LABEL_NAME":"METRONIDAZOLE 500 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904714110","LABEL_NAME":"METHOTREXATE 2.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904714461","LABEL_NAME":"DRONABINOL 2.5 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904714504","LABEL_NAME":"DRONABINOL 5 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904715661","LABEL_NAME":"METRONIDAZOLE 250 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904716507","LABEL_NAME":"AMINOCAPROIC ACID 500 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904718361","LABEL_NAME":"DOCUSATE SODIUM 100 MG SOFTGEL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00904719461","LABEL_NAME":"CLINDAMYCIN HCL 300 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904720806","LABEL_NAME":"NIFEDIPINE ER 30 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904721261","LABEL_NAME":"TRAZODONE 150 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904721761","LABEL_NAME":"DILTIAZEM 24H ER(CD) 120 MG CP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904721861","LABEL_NAME":"DILTIAZEM 24H ER(CD) 180 MG CP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904721961","LABEL_NAME":"DILTIAZEM 24H ER(CD) 240 MG CP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904722061","LABEL_NAME":"DILTIAZEM 24H ER(CD) 300 MG CP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904722461","LABEL_NAME":"FOLIC ACID 1 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904722961","LABEL_NAME":"NIFEDIPINE 10 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904724361","LABEL_NAME":"CIPROFLOXACIN HCL 500 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904724468","LABEL_NAME":"LACOSAMIDE 50 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904724568","LABEL_NAME":"LACOSAMIDE 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904724668","LABEL_NAME":"LACOSAMIDE 150 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904724768","LABEL_NAME":"LACOSAMIDE 200 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904724804","LABEL_NAME":"SIROLIMUS 1 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904725435","LABEL_NAME":"DABIGATRAN ETEXILATE 110 MG CP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904726261","LABEL_NAME":"OXCARBAZEPINE 150 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904726361","LABEL_NAME":"OXCARBAZEPINE 300 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904730961","LABEL_NAME":"ENALAPRIL MALEATE 2.5 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904731061","LABEL_NAME":"ENALAPRIL MALEATE 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904731161","LABEL_NAME":"ENALAPRIL MALEATE 10 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904731261","LABEL_NAME":"ENALAPRIL MALEATE 20 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904731310","LABEL_NAME":"BUDESONIDE DR 3 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904731427","LABEL_NAME":"ACETAMINOPHEN ER 650 MG CAPLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00904731561","LABEL_NAME":"RIFAMPIN 300 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904734561","LABEL_NAME":"FLUOXETINE HCL 10 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904734661","LABEL_NAME":"FLUOXETINE HCL 20 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904735504","LABEL_NAME":"LURASIDONE HCL 20 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904735661","LABEL_NAME":"LURASIDONE HCL 40 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904735761","LABEL_NAME":"LURASIDONE HCL 60 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904735861","LABEL_NAME":"LURASIDONE HCL 80 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904735904","LABEL_NAME":"LURASIDONE HCL 120 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904736061","LABEL_NAME":"RISPERIDONE 0.25 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904736161","LABEL_NAME":"RISPERIDONE 0.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904736261","LABEL_NAME":"RISPERIDONE 1 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904736361","LABEL_NAME":"RISPERIDONE 2 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904736461","LABEL_NAME":"RISPERIDONE 3 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904736561","LABEL_NAME":"RISPERIDONE 4 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904736604","LABEL_NAME":"ARIPIPRAZOLE 2 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904736806","LABEL_NAME":"ARIPIPRAZOLE 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904736904","LABEL_NAME":"ARIPIPRAZOLE 15 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904737004","LABEL_NAME":"ARIPIPRAZOLE 20 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904737104","LABEL_NAME":"ARIPIPRAZOLE 30 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904737561","LABEL_NAME":"MECLIZINE 12.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904737661","LABEL_NAME":"MECLIZINE 25 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904738106","LABEL_NAME":"PROCHLORPERAZINE 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904738206","LABEL_NAME":"PROCHLORPERAZINE 10 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904738361","LABEL_NAME":"TAMSULOSIN HCL 0.4 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904739289","LABEL_NAME":"DROXIDOPA 100 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904739389","LABEL_NAME":"DROXIDOPA 200 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904739489","LABEL_NAME":"DROXIDOPA 300 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904741661","LABEL_NAME":"PHENYTOIN SOD EXT 100 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904743405","LABEL_NAME":"OFLOXACIN 0.3% EYE DROPS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904744761","LABEL_NAME":"HYDRALAZINE 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904744861","LABEL_NAME":"HYDRALAZINE 25 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904744961","LABEL_NAME":"HYDRALAZINE 50 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904745061","LABEL_NAME":"HYDRALAZINE 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904745161","LABEL_NAME":"LABETALOL HCL 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904745261","LABEL_NAME":"LABETALOL HCL 200 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904745361","LABEL_NAME":"LABETALOL HCL 300 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904746904","LABEL_NAME":"BUPROPION HCL XL 300 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904748159","LABEL_NAME":"ACETAMINOPHEN 1,000 MG/30 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00904748303","LABEL_NAME":"ROFLUMILAST 500 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904749371","LABEL_NAME":"ROFLUMILAST 250 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904749506","LABEL_NAME":"OMEGA-3 ETHYL ESTERS 1 GM CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904749704","LABEL_NAME":"NEBIVOLOL 2.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904749804","LABEL_NAME":"NEBIVOLOL 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904749904","LABEL_NAME":"NEBIVOLOL 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904750604","LABEL_NAME":"RANOLAZINE ER 500 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904750761","LABEL_NAME":"ACYCLOVIR 400 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904751961","LABEL_NAME":"ACYCLOVIR 200 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904752208","LABEL_NAME":"DOFETILIDE 125 MCG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904752308","LABEL_NAME":"DOFETILIDE 250 MCG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904752408","LABEL_NAME":"DOFETILIDE 500 MCG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904753259","LABEL_NAME":"ACETAMINOPHEN 500 MG/15 ML LIQ","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00904753315","LABEL_NAME":"CHILD ALLERGY RLF 12.5 MG/5 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00904754210","LABEL_NAME":"CEFUROXIME AXETIL 250 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904754361","LABEL_NAME":"POTASSIUM CL ER 10 MEQ CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904756462","LABEL_NAME":"MILK OF MAGNESIA SUSP 30ML CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00904758004","LABEL_NAME":"SACUBITRIL-VALSARTAN 24-26 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904758104","LABEL_NAME":"SACUBITRIL-VALSARTAN 97-103 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904758204","LABEL_NAME":"SACUBITRIL-VALSARTAN 49-51 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"00904773445","LABEL_NAME":"MICONAZOLE 7 CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00904791459","LABEL_NAME":"IBU-200 200 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"00990713809","LABEL_NAME":"SODIUM CHLORIDE 0.9% IRRIG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"02340009000","LABEL_NAME":"DUREX TROPICAL CONDOM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"02340012900","LABEL_NAME":"DUREX EXTRA SENSITIVE CONDOM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"02340089455","LABEL_NAME":"DUREX AVANTI REAL FEEL CONDOM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"03999060069","LABEL_NAME":"DROPSAFE INS SYR 0.3ML 31G 8MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"03999060071","LABEL_NAME":"DROPSAFE INS SYR 0.5ML 31G 8MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"03999060072","LABEL_NAME":"DROPSAFE INSULN 1ML 29G 12.5MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"03999060073","LABEL_NAME":"DROPSAFE INSUL SYR 1ML 31G 8MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"03999060077","LABEL_NAME":"DROPSAFE INS SYR 0.5ML 31G 6MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"03999060078","LABEL_NAME":"DROPSAFE INS SYR 0.3ML 31G 6MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"03999060079","LABEL_NAME":"DROPSAFE INSUL SYR 1ML 31G 6MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"03999060201","LABEL_NAME":"DROPSAFE ACTI-LANCE 23G LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"04351024010","LABEL_NAME":"COMFORTSEAL MEDIUM MASK","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"04351034010","LABEL_NAME":"COMFORTSEAL SMALL MASK","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"04351044010","LABEL_NAME":"COMFORTSEAL LARGE MASK","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"04351050012","LABEL_NAME":"AEROCHAMBER PLUS FLOW-VU","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"04351050112","LABEL_NAME":"AEROCHAMBER PLUS FLOW-VU SMALL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"04351050212","LABEL_NAME":"AEROCHAMBER PLUS FLOW-VU MED","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"04351050312","LABEL_NAME":"AEROCHAMBER PLUS FLOW-VU LARGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"04351050612","LABEL_NAME":"AEROCHAMBER2GO","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"04351078710","LABEL_NAME":"AEROCHAMBER Z-STAT PLUS-MED","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"04351078810","LABEL_NAME":"AEROCHAMBER PLUS FLOW-VU MED","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"04351079710","LABEL_NAME":"AEROCHAMBER Z-STAT PLUS W-FLOW","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"04351080710","LABEL_NAME":"AEROCHAMBER Z-STAT PLUS LARGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"04351080810","LABEL_NAME":"AEROCHAMBER PLUS FLOW-VU LARGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"04351085810","LABEL_NAME":"AEROVENT PLUS HOLDING CHAMBER","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"04351088710","LABEL_NAME":"AEROCHAMBER Z-STAT PLUS-SMALL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"04351088810","LABEL_NAME":"AEROCHAMBER PLUS FLOW-VU SMALL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"04351098510","LABEL_NAME":"AEROCHAMBER MV HOLD CHAMBER","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"04351098550","LABEL_NAME":"AEROCHAMBER MECHANICAL VENT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"04351098810","LABEL_NAME":"AEROCHAMBER MINI","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"05632083005","LABEL_NAME":"TRUSTEX CONDOM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"05632083010","LABEL_NAME":"TRUSTEX-RIA CONDOM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"05632083050","LABEL_NAME":"TRUSTEX-RIA CONDOM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"05632084010","LABEL_NAME":"TRUSTEX LATEX CONDOM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"05632084140","LABEL_NAME":"TRUSTEX CONDOM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"05632086805","LABEL_NAME":"FANTASY CONDOM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08011041170","LABEL_NAME":"TOOMEY SYRINGE 70 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08080032010","LABEL_NAME":"MONOJECT SYRINGE 3 ML 20GX1","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08080100555","LABEL_NAME":"MONOJECT TUBERCULIN SYR 1 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08080100777","LABEL_NAME":"MONOJECT LUER LOCK TB SYR 1 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08080125058","LABEL_NAME":"MONOJECT 1 ML TB SYRN 25X5/8\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08080126038","LABEL_NAME":"MONOJECT TB 1 ML SYRN 26X3/8\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08080127012","LABEL_NAME":"MONOJECT TB 1 ML SYRN 27GX1/2","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08080128012","LABEL_NAME":"MONOJECT TB 1 ML SYRN 28GX1/2","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08080300555","LABEL_NAME":"MONOJECT SYRINGE 3 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08080320112","LABEL_NAME":"MONOJECT SYRN 3 ML 20GX1-1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08080321100","LABEL_NAME":"MONOJECT 3 ML SYRINGE 21GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08080321112","LABEL_NAME":"MONOJECT 3 ML SYRN 21GX1-1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08080322100","LABEL_NAME":"MONOJECT SYRINGE 3 ML 22GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08080322112","LABEL_NAME":"MONOJECT 3 ML SYRN 22GX1-1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08080323100","LABEL_NAME":"MONOJECT 3 ML SYRINGE 23GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08080325058","LABEL_NAME":"MONOJECT 3 ML SYRN 25GX5/8\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08080325100","LABEL_NAME":"MONOJECT 3 ML SYRINGE 25GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08080325114","LABEL_NAME":"MONOJECT 3 ML SYRN 25GX1.25\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08080327114","LABEL_NAME":"MONOJECT 3 ML SYRN 27GX1.25\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08080501459","LABEL_NAME":"MONOJECT PHARMACY TRAY","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08080600555","LABEL_NAME":"MONOJECT SYRINGE 6 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08080620112","LABEL_NAME":"MONOJECT 6 ML SYRN 20GX11/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08080621100","LABEL_NAME":"MONOJECT 6 ML SYRN 21GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08080621112","LABEL_NAME":"MONOJECT 6 ML SYRN 21GX11/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08080622112","LABEL_NAME":"MONOJECT 6 ML SYRN 22GX11/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08080810055","LABEL_NAME":"MONOJECT SYRINGE 1 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08080812701","LABEL_NAME":"MONOJECT 1 ML SYRN 27X1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08080812801","LABEL_NAME":"MONOJECT 1 ML SYRN 28GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08080818100","LABEL_NAME":"MONOJECT HYPO NEEDLE 18X1A","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08080818112","LABEL_NAME":"MONOJECT HYPODERMIC NEEDLE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08080819100","LABEL_NAME":"MONOJECT HYPO NEEDLE 19X1","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08080819112","LABEL_NAME":"MONOJECT HYPO NEEDLE 19X1-1/2","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08080820100","LABEL_NAME":"MONOJECT HYPO NEEDLE 20X1","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08080820112","LABEL_NAME":"MONOJECT HYPO NEEDLE 20X1-1/2","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08080821100","LABEL_NAME":"MONOJECT HYPO NEEDLE 21X1","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08080821112","LABEL_NAME":"MONOJECT HYPO NEEDLE 21X1-1/2","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08080822100","LABEL_NAME":"MONOJECT HYPO NEEDLE 22X1","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08080822112","LABEL_NAME":"MONOJECT HYPO NEEDLE 22X1.5","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08080823100","LABEL_NAME":"MONOJECT HYPO NEEDLE 23X1","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08080825058","LABEL_NAME":"MONOJECT HYPO NEEDLE 25X5/8","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08080825100","LABEL_NAME":"MONOJECT HYPO NEEDLE 25X1","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08080825112","LABEL_NAME":"MONOJECT HYPO NEEDLE 25X1.5","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08080826112","LABEL_NAME":"MONOJECT HYPO NEEDLE 26X1.5","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08080827012","LABEL_NAME":"MONOJECT HYPO NEEDLE 27X0.5","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08080827112","LABEL_NAME":"MONOJECT HYPO NDL 27GX1-1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08080830340","LABEL_NAME":"MONOJECT HYPO NEEDLE 30X3/4","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08080852801","LABEL_NAME":"MONOJECT 0.5 ML SYRN 28GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08137003405","LABEL_NAME":"PERSA-GEL 10%","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08214025720","LABEL_NAME":"ULTRA THIN 28G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08214025727","LABEL_NAME":"INCONTROL ULTRA THIN 28G LANCT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08214025739","LABEL_NAME":"UNILET ULTRA THIN 28G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08214027020","LABEL_NAME":"ADVANCED LANCING DEVICE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08214027033","LABEL_NAME":"QC AUTOLET LANCING DEVICE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08214027080","LABEL_NAME":"KRO AUTOLET LANCING DEVICE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08214027429","LABEL_NAME":"ADVANCED LANCING DEVICE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08214028739","LABEL_NAME":"ON-THE-GO 30G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08214035721","LABEL_NAME":"CAREONE ULTRA THIN LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08214043520","LABEL_NAME":"ALTERNATE SITE 26G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08214046520","LABEL_NAME":"SUPER THIN 30G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08214046533","LABEL_NAME":"QC UNILET SUPER THIN 30G LANCT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08214056529","LABEL_NAME":"LANCETS 28G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08214056533","LABEL_NAME":"QC UNILET ULTRA THIN 28G LANCT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08214057761","LABEL_NAME":"UNILET SUPER THIN 30G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08214058529","LABEL_NAME":"PUB MICRO THIN 33G LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08214058539","LABEL_NAME":"UNILET MICRO THIN 33G LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08214058733","LABEL_NAME":"UNILET MICRO THIN 33G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08214065727","LABEL_NAME":"INCONTROL SUPER THIN 30G LANCT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08214070721","LABEL_NAME":"CAREONE LANCING DEVICE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08214070727","LABEL_NAME":"INCONTROL LANCING DEVICE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08214070729","LABEL_NAME":"PUB ADVANCED LANCING DEVICE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08214070734","LABEL_NAME":"LANCING DEVICE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08214070748","LABEL_NAME":"AUTOLET LANCING DEVICE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08214085727","LABEL_NAME":"HEB MICRO THIN 33G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08214535716","LABEL_NAME":"PC SUPER THIN 30G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08222025432","LABEL_NAME":"YOURX ULTICARE PEN NDL 4MM 32G","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08222025630","LABEL_NAME":"YOURX ULTICARE PEN NDL 6MM 31G","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08222025838","LABEL_NAME":"YOURX ULTICARE PEN NDL 8MM 31G","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08222032195","LABEL_NAME":"ULTICARE INS SAFETY 1ML 29X1/2","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08222032591","LABEL_NAME":"ULTICARE SAFETY 0.5 ML 29GX1/2","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08222051257","LABEL_NAME":"ULTICARE LDS SYR 1 ML 22G 1.5\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08222053251","LABEL_NAME":"ULTICARE LDS SYR 3 ML 22GX1.5\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08222073150","LABEL_NAME":"ULTICARE SYRINGE 1 ML 30GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08222073358","LABEL_NAME":"ULTICARE SYR 0.3 ML 30GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08222073556","LABEL_NAME":"ULTICARE SYR 0.5 ML 30GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08222074195","LABEL_NAME":"ULTICARE SYR 1 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08222074393","LABEL_NAME":"ULTICARE SYR 0.3 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08222074591","LABEL_NAME":"ULTICARE SYR 0.5 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08222082183","LABEL_NAME":"ULTICARE INS SYR 1 ML 28GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08222082589","LABEL_NAME":"ULTICARE SYRIN 0.5 ML 28GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08222092199","LABEL_NAME":"ULTICARE INS SYR 1 ML 29GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08222092397","LABEL_NAME":"ULTICARE SYRIN 0.3 ML 29GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08222092595","LABEL_NAME":"ULTICARE SYR 0.5 ML 29GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08222093158","LABEL_NAME":"ULTICARE INS SYR 1 ML 30GX1/2\"","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08222093196","LABEL_NAME":"ULTICARE SYR 1 ML 30GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08222093356","LABEL_NAME":"ULTICARE INS 0.3 ML 30GX1/2\"","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08222093394","LABEL_NAME":"ULTICARE SYR 0.3 ML 30GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08222093554","LABEL_NAME":"ULTICARE INS 0.5 ML 30GX1/2\"","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08222093592","LABEL_NAME":"ULTICARE SYR 0.5 ML 30GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08222094193","LABEL_NAME":"ULTCARE INS SYR 1 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08222094391","LABEL_NAME":"ULTICARE SYR 0.3 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08222094599","LABEL_NAME":"ULTICARE SYR 0.5 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08222095121","LABEL_NAME":"ULTICARE PEN NEEDLES 12MM 29G","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08222095459","LABEL_NAME":"ULTICARE PEN NEEDLES 4MM 32G","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08222095534","LABEL_NAME":"ULTICARE PEN NEEDLE 31GX3/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08222095626","LABEL_NAME":"ULTICARE PEN NEEDLES 6MM 32G","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08222095633","LABEL_NAME":"ULTICARE PEN NEEDLES 6MM 31G","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08222095657","LABEL_NAME":"ULTICARE PEN NEEDLE 6MM 31G","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08222095831","LABEL_NAME":"ULTICARE PEN NEEDLES 8MM 31G","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08222095855","LABEL_NAME":"ULTICARE PEN NEEDLE 8 MM 31G","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08222123152","LABEL_NAME":"ULTIGUARD SAFE 1ML 30G 12.7MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08222123350","LABEL_NAME":"ULTIGUARD SAFE0.3ML 30G 12.7MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08222123558","LABEL_NAME":"ULTIGUARD SAFE0.5ML 30G 12.7MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08222124197","LABEL_NAME":"ULTIGUARD SAFEPACK 1ML 31G 8MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08222124395","LABEL_NAME":"ULTIGUARD SAFEPK 0.3ML 31G 8MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08222124593","LABEL_NAME":"ULTIGUARD SAFEPK 0.5ML 31G 8MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08222142387","LABEL_NAME":"HM ULTICARE PEN NEEDLE 4MM 32G","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08222142394","LABEL_NAME":"HM ULTICARE PEN NEEDLE 8MM 31G","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08222142400","LABEL_NAME":"HM ULTICARE PEN NEEDLE 6MM 31G","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08222143896","LABEL_NAME":"HM ULTICARE PEN NEEDLE 5MM 31G","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08222251107","LABEL_NAME":"ULTICARE TB SAFETY 1 ML 25GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08222251589","LABEL_NAME":"ULTICARE TB SAFETY 1ML 25GX5/8","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08222630001","LABEL_NAME":"ULTICARE TB SAFETY 1ML 27GX5/8","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08222630018","LABEL_NAME":"ULTICARE TB SAFETY 1ML 27GX1/2","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08222630025","LABEL_NAME":"ULTICARE TB SAFETY 1ML 28GX1/2","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08222630032","LABEL_NAME":"ULTICARE SAFETY 3 ML 21GX1-1/2","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08222630049","LABEL_NAME":"ULTICARE SAFETY 3 ML 22GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08222630056","LABEL_NAME":"ULTICARE SAFETY 3 ML 22GX1-1/2","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08222630063","LABEL_NAME":"ULTICARE SAFETY 3 ML 23GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08222630070","LABEL_NAME":"ULTICARE SAFETY 3 ML 25GX5/8\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08222630087","LABEL_NAME":"ULTICARE SAFETY 3 ML 25GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08222630148","LABEL_NAME":"ULTICARE SAFETY SYRINGE 3 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08222678006","LABEL_NAME":"INCONTROL ULTICARE NDL 31G 6MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08222678044","LABEL_NAME":"INCONTROL ULTICARE NDL 31G 8MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08222710062","LABEL_NAME":"ULTICARE PEN NDL 12.7 MM 29G","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08222710079","LABEL_NAME":"ULTICARE PEN NEEDLE 4MM 32G","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08222710093","LABEL_NAME":"ULTICARE PEN NEEDLE 8MM 31G","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08222719372","LABEL_NAME":"INCONTROL ULTICARE NDL 32G 4MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08222720031","LABEL_NAME":"GNP ULTICARE PEN NDL 32G 4MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08222720055","LABEL_NAME":"GNP ULTICARE PEN NDL 31G 8MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08222720085","LABEL_NAME":"GNP ULTICARE PEN NDL 32G 6MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08222720130","LABEL_NAME":"GNP ULTICARE PEN NDL 31G 5MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08222910066","LABEL_NAME":"ULTICARE INS 0.3 ML 31GX1/4\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08222910073","LABEL_NAME":"ULTICAR INS 0.3ML 31GX1/4(1/2)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08222910080","LABEL_NAME":"ULTICARE INS 0.5 ML 31GX1/4\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08222910097","LABEL_NAME":"ULTICARE INS 1 ML 31GX1/4\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08287126014","LABEL_NAME":"EXEL U100 0.3 ML 30GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08287126015","LABEL_NAME":"EXEL U100 0.5 ML 30GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08287126016","LABEL_NAME":"EXEL U100 1 ML 30GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08287126018","LABEL_NAME":"EXEL U100 0.3 ML 29GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08287126026","LABEL_NAME":"EXEL U100 0.5 ML 28GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08287126027","LABEL_NAME":"EXEL INS SYR U100 1 ML 28GX1/2","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08287126028","LABEL_NAME":"EXEL U100 0.5 ML 29GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08287126029","LABEL_NAME":"EXEL U100 INS SYR 1 ML 29GX1/2","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08287126040","LABEL_NAME":"EXEL TB WITH NEEDLE 27GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08287126042","LABEL_NAME":"EXEL TB WITH NEEDLE 26GX3/8\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08287126044","LABEL_NAME":"EXEL TB WITH NEEDLE 25GX5/8\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08287126048","LABEL_NAME":"EXEL TUBERCULIN SYRINGE 1 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08287126061","LABEL_NAME":"ALLERGY SYRINGE 1 ML 27GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08287126063","LABEL_NAME":"ALLERGY SYRINGE 1 ML 27GX3/8\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08287126101","LABEL_NAME":"EXEL SYRINGE 23GX1\" 3 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08287126102","LABEL_NAME":"EXEL SYRINGE 22GX1\" 3 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08287126104","LABEL_NAME":"EXEL SYRINGE 22GX1-1/2\" 3 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08287126105","LABEL_NAME":"EXEL SYRINGE 21GX1\" 3 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08287126107","LABEL_NAME":"EXEL SYRINGE 21GX1-1/2\" 3 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08287126108","LABEL_NAME":"EXEL SYRINGE 20GX1\" 3 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08287126109","LABEL_NAME":"EXEL SYRINGE 20GX1-1/2\" 3 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08287126111","LABEL_NAME":"EXEL SYRINGE 25GX1\" 3 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08287126115","LABEL_NAME":"EXEL SYRINGE 22GX3/4\" 3 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08287126129","LABEL_NAME":"EXEL 3 ML SYRN 27G X 1 1/4\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08287126200","LABEL_NAME":"EXEL SYRINGE 3 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08287126230","LABEL_NAME":"EXEL SYRINGE 5 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08287126400","LABEL_NAME":"EXEL HYPO NEEDLE 27GX0.5\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08287126401","LABEL_NAME":"EXEL HYPO NEEDLE 26GX0.375\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08287126402","LABEL_NAME":"EXEL HYPO NEEDLE 26GX0.5\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08287126403","LABEL_NAME":"EXEL HYPO NEEDLE 25GX0.625\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08287126405","LABEL_NAME":"EXEL HYPO NEEDLE 25GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08287126406","LABEL_NAME":"EXEL HYPO NEEDLE 25GX1.5\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08287126407","LABEL_NAME":"EXEL HYPO NEEDLE 23GX0.75\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08287126408","LABEL_NAME":"EXEL HYPO NEEDLE 23GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08287126410","LABEL_NAME":"EXEL HYPO NEEDLE 22GX0.75\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08287126411","LABEL_NAME":"EXEL HYPO NEEDLE 22GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08287126412","LABEL_NAME":"EXEL HYPO NEEDLE 22GX1.5\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08287126414","LABEL_NAME":"EXEL HYPO NEEDLE 21GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08287126416","LABEL_NAME":"EXEL HYPO NEEDLE 21GX1.5\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08287126417","LABEL_NAME":"EXEL HYPO NEEDLE 20GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08287126418","LABEL_NAME":"EXEL HYPO NEEDLE 20GX1.5\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08287126419","LABEL_NAME":"EXEL HYPO NEEDLE 18GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08287126420","LABEL_NAME":"EXEL HYPO NEEDLE 18GX1.5\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08287126421","LABEL_NAME":"EXEL HYPO NEEDLE 16GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08287126424","LABEL_NAME":"EXEL HYPO NEEDLE 19GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08287126425","LABEL_NAME":"EXEL HYPO NEEDLE 25GX0.75\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08287126426","LABEL_NAME":"EXEL HYPO NEEDLE 26GX1.5\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08287126430","LABEL_NAME":"EXEL HYPO NEEDLE 20GX0.75\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08287126437","LABEL_NAME":"EXEL HYPO NEEDLE 30GX0.5\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08287126438","LABEL_NAME":"EXEL HYPO NEEDLE 19GX1.5\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08287126440","LABEL_NAME":"EXEL HYPO NEEDLE 26GX0.625\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08287126501","LABEL_NAME":"EXEL MTI DRAWING NDL 20GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08287126503","LABEL_NAME":"EXEL MTI DRAWING NDL 21GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08287126505","LABEL_NAME":"EXEL MTI DRAWING NDL 22GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08287126902","LABEL_NAME":"EXEL HUBER 22GX3/4\" NEEDLE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08287126904","LABEL_NAME":"EXEL HUBER NEEDLE 22GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290301025","LABEL_NAME":"BD BULK SYRINGE 1 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08290301027","LABEL_NAME":"BD BULK SYRINGE 5 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08290301029","LABEL_NAME":"BD BULK SYRINGE 10 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08290301604","LABEL_NAME":"BD 10 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08290301629","LABEL_NAME":"BD PRECISIONGLI 27GX1-1/2\" NDL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290303005","LABEL_NAME":"BD NEEDLE 18GX1 1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290303006","LABEL_NAME":"BD NEEDLE 19GX1 1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290303007","LABEL_NAME":"BD NEEDLE 20GX1 1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290303008","LABEL_NAME":"BD NEEDLE 21GX1 1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290303010","LABEL_NAME":"BD NEEDLE 25GX5/8\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290303011","LABEL_NAME":"BD NEEDLE 23GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290303012","LABEL_NAME":"BD NEEDLE 25GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290303134","LABEL_NAME":"BD SYRINGE SLIP TIP 10 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290303302","LABEL_NAME":"BD PRECISIONGLIDE NDL 27G 3/8\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290303306","LABEL_NAME":"BD ECLIPSE SYRNG 3 ML 23G 40MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08290303327","LABEL_NAME":"BD SAFETYGLIDE TB 1ML 27G 10MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290303344","LABEL_NAME":"BD TB ST SYRINGE 1 ML 27G 10MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08290304387","LABEL_NAME":"BD SAFETYGLIDE NEEDLE 23G 40MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290305106","LABEL_NAME":"BD NEEDLES 30GX0.5\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290305109","LABEL_NAME":"BD NEEDLES 27GX0.5\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290305110","LABEL_NAME":"BD NEEDLES 26GX0.375\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290305111","LABEL_NAME":"BD NEEDLES 26GX0.5\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290305115","LABEL_NAME":"BD NEEDLE 26GX0.625\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290305120","LABEL_NAME":"BD NEEDLES 23GX1.25\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290305122","LABEL_NAME":"BD NEEDLES 25GX0.625\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290305124","LABEL_NAME":"BD NEEDLES 25GX0.875\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290305125","LABEL_NAME":"BD PRECISIONGLIDE NEEDLE 25G","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290305127","LABEL_NAME":"BD NEEDLES 25GX1.5\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290305128","LABEL_NAME":"BD NEEDLES 30GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290305129","LABEL_NAME":"BD NEEDLES 21GX2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290305136","LABEL_NAME":"BD NEEDLES 27GX1X1.25\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290305143","LABEL_NAME":"BD NEEDLES 23GX0.75\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290305165","LABEL_NAME":"BD NEEDLES 21GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290305166","LABEL_NAME":"YALE NEEDLES 21GX1.25\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290305167","LABEL_NAME":"BD NEEDLES 21GX1.5\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290305175","LABEL_NAME":"BD NEEDLES 20GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290305176","LABEL_NAME":"BD NEEDLES 20GX1.5\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290305177","LABEL_NAME":"BD NEEDLE 21GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290305180","LABEL_NAME":"BD BLUNT NEEDLE 18GX1-1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290305186","LABEL_NAME":"BD NEEDLES 19GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290305187","LABEL_NAME":"BD NEEDLES 19GX1.5\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290305194","LABEL_NAME":"BD NEEDLE 23GX1 1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290305195","LABEL_NAME":"BD NEEDLES 18GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290305196","LABEL_NAME":"BD NEEDLES 18GX1.5\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290305197","LABEL_NAME":"BD NEEDLES 16GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290305198","LABEL_NAME":"BD NEEDLES 16GX1.5\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290305269","LABEL_NAME":"BD INTEGRA SYR 3 ML 25GX5/8\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08290305270","LABEL_NAME":"BD INTEGRA SYRINGE 3 ML 25GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08290305271","LABEL_NAME":"BD INTEGRA SYRINGE 3 ML 23GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08290305273","LABEL_NAME":"BD INTEGRA SYRINGE 3 ML 21GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290305274","LABEL_NAME":"BD INTEGRA SYR 3 ML 21GX1 1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08290305310","LABEL_NAME":"BD INTEGRA NEEDLE 25G X 5/8\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290305312","LABEL_NAME":"BD INTEGRA RETRA NEEDLE 23GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290305500","LABEL_NAME":"BD ALLERGY SYRINGE-NEEDLE 1 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08290305620","LABEL_NAME":"BD TB SYRNGE 27GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08290305712","LABEL_NAME":"BD ECLIPSE NEEDLE 18G 40MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290305757","LABEL_NAME":"BD ECLIPSE NEEDLE 30G 13MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290305759","LABEL_NAME":"BD ECLIPSE NEEDLE 25G 16MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290305761","LABEL_NAME":"BD ECLIPSE NEEDLE 25GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290305762","LABEL_NAME":"BD ECLIPSE NEEDLE 23GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290305764","LABEL_NAME":"BD ECLIPSE NEEDLE 21GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290305765","LABEL_NAME":"BD ECLIPSE NEEDLES 21GX1.5\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290305766","LABEL_NAME":"BD ECLIPSE NEEDLE 18GX1 1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290305767","LABEL_NAME":"BD ECLIPSE NEEDLE 25GX1.5\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290305778","LABEL_NAME":"BD ECLIPSE 30GX1/2\" SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290305779","LABEL_NAME":"BD ECLIPSE SYRINGE 3 ML 21GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290305780","LABEL_NAME":"BD ECLIPSE SYR 1 ML 25GX5/8","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08290305781","LABEL_NAME":"BD ECLIPSE LUER-LOK SYR 3 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08290305787","LABEL_NAME":"BD ECLIPSE SYRINGE 3 ML 25GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290305789","LABEL_NAME":"BD ECLIPSE LUER-LOK SYR 1 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08290305826","LABEL_NAME":"BD ECLIPSE NEEDLE 23G 25MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290305837","LABEL_NAME":"BD ECLIPSE NEEDLE 25G 25MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290305838","LABEL_NAME":"BD ECLIPSE NEEDLE 25G 40MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290305901","LABEL_NAME":"BD SAFETYGLIDE NEEDLE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290305903","LABEL_NAME":"BD SYRINGE-SAFETY GLIDE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08290305904","LABEL_NAME":"BD SYRINGE-SAFETY GLIDE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08290305905","LABEL_NAME":"BD SAFETYGLIDE 3 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08290305909","LABEL_NAME":"BD SAFETYGLIDE 3 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08290305915","LABEL_NAME":"BD SAFETYGLIDE NEEDLE 21GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290305916","LABEL_NAME":"BD SAFETYGLIDE NEEDLE 25GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290305917","LABEL_NAME":"BD SAFETYGLIDE NEEDLE 21GX1.5\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290305918","LABEL_NAME":"BD SAFETYGLIDE NEEDLE 18GX1.5\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290305921","LABEL_NAME":"BD SAFETYGLIDE NEEDLE 27GX5/8\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290305924","LABEL_NAME":"BD SAFETYGLIDE SYR 3 ML 25GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08290305927","LABEL_NAME":"BD SAFETYGLIDE SYRINGE 27GX5/8","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290305930","LABEL_NAME":"BD SAFETYGLD INS 1 ML 29G 13MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290305932","LABEL_NAME":"BD SAFTYGLD INS 0.5ML 29G 13MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290305934","LABEL_NAME":"BD SAFETYGLD INS 0.5ML 30G 8MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290305935","LABEL_NAME":"BD SAFETGLD INS 0.3ML 29G 13MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290305937","LABEL_NAME":"BD SAFETYGLD INS 0.3ML 31G 8MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290305945","LABEL_NAME":"BD SAFETYGLIDE TB 1 ML SYR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08290305950","LABEL_NAME":"BD SAFETYGLIDE ALLERGY 27G SYR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290305951","LABEL_NAME":"BD SAFETYGLIDE ALLERGY SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08290308341","LABEL_NAME":"BD SYRINGE-LUER TIP CAP","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08290309570","LABEL_NAME":"BD LUER-LOK SYR 3 ML 25GX5/8\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08290309571","LABEL_NAME":"BD 3 ML SYRINGE WITH NEEDLE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08290309579","LABEL_NAME":"BD 3 ML SYRINGE 20GX1-1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08290309580","LABEL_NAME":"BD 3 ML SYRINGE 18GX1-1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08290309581","LABEL_NAME":"BD 3 ML SYRINGE 25GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08290309582","LABEL_NAME":"BD 3 ML SYRINGE 25GX1-1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08290309597","LABEL_NAME":"BD 1 ML SYRINGE WITH NEEDLE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08290309605","LABEL_NAME":"BD 10 ML SYRINGE BULK","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08290309623","LABEL_NAME":"BD TB SYRINGE 27GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290309624","LABEL_NAME":"BD TB SYRINGE 21GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08290309625","LABEL_NAME":"BD TB SYRINGE 26GX3/8\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08290309626","LABEL_NAME":"BD TB SYRINGE 25GX5/8\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08290309628","LABEL_NAME":"BD LUER-LOK SYRINGE 1 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08290309632","LABEL_NAME":"BD 5 ML SYRINGE 21GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08290309633","LABEL_NAME":"BD 5 ML SYRINGE 21GX1-1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08290309634","LABEL_NAME":"BD 5 ML SYRINGE 20GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08290309635","LABEL_NAME":"BD 5 ML SYRINGE 20GX1-1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08290309637","LABEL_NAME":"BD LUER-LOK SYRINGE 1ML 20GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08290309642","LABEL_NAME":"BD 10 ML SYRINGE 21GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08290309643","LABEL_NAME":"BD 10 ML SYRINGE 21GX1-1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08290309644","LABEL_NAME":"BD 10 ML SYRINGE 20GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08290309645","LABEL_NAME":"BD 10 ML SYRINGE 20GX1-1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08290309646","LABEL_NAME":"BD LUER-LOK 5 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290309647","LABEL_NAME":"BD SLIP TIP 5 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08290309656","LABEL_NAME":"BD 3 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08290309657","LABEL_NAME":"BD SYRINGE 3 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08290309659","LABEL_NAME":"BD TUBERCULIN 1 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08290309695","LABEL_NAME":"BD 10 ML CONTROL SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08290309701","LABEL_NAME":"BD LUERSLIP SYRINGE 1 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08290309702","LABEL_NAME":"BD LUER-LOK SYRINGE 3 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08290309703","LABEL_NAME":"BD LUER-LOK SYRINGE 5 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08290328446","LABEL_NAME":"BD SAFETYGLID INS 1 ML 6MMX31G","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290328447","LABEL_NAME":"BD SAFTYGLD INS 0.5 ML 6MMX31G","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290328449","LABEL_NAME":"BD SAFTYGLD INS 0.3 ML 6MMX31G","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08290366592","LABEL_NAME":"BD MICROTAINER 30G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08290366593","LABEL_NAME":"BD MICROTAINER 21G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08290366594","LABEL_NAME":"BD MICROTAINER LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08290405071","LABEL_NAME":"BD QUINCKE SPNL NDL 20GX2 1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08290405160","LABEL_NAME":"BD QUINCKE SPNL NDL 20GX1 1/4\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08290593001","LABEL_NAME":"BD SAFETYGLD INS 1 ML 29G 13MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08317260303","LABEL_NAME":"TECHLITE 0.5 ML 30GX12MM (1/2)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08317260305","LABEL_NAME":"TECHLITE INS SYR 1 ML 30GX12MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08317260311","LABEL_NAME":"TECHLITE 0.3 ML 31GX8MM (1/2)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08317260312","LABEL_NAME":"TECHLITE 0.5 ML 31GX8MM (1/2)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08317260313","LABEL_NAME":"TECHLITE INS SYR 1 ML 31GX8MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08317260314","LABEL_NAME":"TECHLITE 0.3 ML 31GX6MM (1/2)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08317260315","LABEL_NAME":"TECHLITE 0.5 ML 31GX6MM (1/2)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08317260316","LABEL_NAME":"TECHLITE INS SYR 1 ML 31GX6MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08317410012","LABEL_NAME":"HYPOLANCE AST LANCING KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08317570015","LABEL_NAME":"LANZO LANCING DEVICE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08317660016","LABEL_NAME":"MULTI-LANCET DEVICE 2 KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08317880126","LABEL_NAME":"TECHLITE 26G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08317880128","LABEL_NAME":"TECHLITE 28G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08317880130","LABEL_NAME":"TECHLITE 30G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08317980121","LABEL_NAME":"ASSURE LANCE PLUS 21G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08317980125","LABEL_NAME":"ASSURE LANCE 25G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08317980128","LABEL_NAME":"ASSURE LANCE 28G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08317980328","LABEL_NAME":"ASSURE LANCE 28G SAFETY LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08317990125","LABEL_NAME":"ASSURE LANCE PLUS 25G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08317990130","LABEL_NAME":"ASSURE LANCE PLUS 30G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08326231001","LABEL_NAME":"ULTILET SAFETY 23G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08326261001","LABEL_NAME":"ULTILET CLASSIC 26G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08326280001","LABEL_NAME":"ULTILET 28G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08326281001","LABEL_NAME":"ULTILET CLASSIC 28G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08326290110","LABEL_NAME":"INSULIN SYRINGE 1 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08326290130","LABEL_NAME":"INSULIN SYRINGE 0.3 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08326290150","LABEL_NAME":"INSULIN SYRINGE 0.5 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08326290310","LABEL_NAME":"ULTILET INSULIN SYRINGE 1 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08326290330","LABEL_NAME":"ULTILET INSULIN SYRINGE 0.3 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08326290350","LABEL_NAME":"ULTILET INSULIN SYRINGE 0.5 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08326300001","LABEL_NAME":"ULTILET 30G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08326300210","LABEL_NAME":"INSULIN SYRINGE 1 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08326300230","LABEL_NAME":"INSULIN SYRINGE 0.3 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08326301001","LABEL_NAME":"ULTILET CLASSIC 30G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08326302001","LABEL_NAME":"ULTILET BASIC 30G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08326330001","LABEL_NAME":"ULTILET 33G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08326331001","LABEL_NAME":"ULTILET CLASSIC 33G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08327006729","LABEL_NAME":"SAFETY 21G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08327006829","LABEL_NAME":"SAFETY 28G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08327006929","LABEL_NAME":"PRESSURE ACTIVATED 21G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08327007029","LABEL_NAME":"PRESSURE ACTIVATED 28G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08373075500","LABEL_NAME":"PERSONAL BEST PEAK FLOW MTR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08373747800","LABEL_NAME":"OPTICHAMBER DIAMOND VHC","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08373982300","LABEL_NAME":"OPTICHAMBER DIAMOND W-SML MASK","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08373982600","LABEL_NAME":"OPTICHAMBER DIAMOND W-MED MASK","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08373982700","LABEL_NAME":"OPTICHAMBER DIAMOND W-LRG MASK","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08396705014","LABEL_NAME":"RA HEALTH CARE LANCING DEVICE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08396706002","LABEL_NAME":"RELION LANCING DEVICE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08396706091","LABEL_NAME":"LANCING DEVICE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08396800100","LABEL_NAME":"ULTRA COMFORT 0.5 ML 28GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08396800200","LABEL_NAME":"ULTRA COMFORT 1 ML 28GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08396800300","LABEL_NAME":"ULT CFT 0.3 ML 29GX1/2\" (1/2)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08396800400","LABEL_NAME":"ULTRA COMFORT 0.5 ML 29GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08396800500","LABEL_NAME":"ULTRA COMFORT 1 ML 29GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08396800800","LABEL_NAME":"ULTRA COMFORT 1 ML 30GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08396800900","LABEL_NAME":"ULT CFT 0.3 ML 31GX5/16\" (1/2)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08396801000","LABEL_NAME":"ULTRA COMFORT 0.5 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08396801100","LABEL_NAME":"ULTRA COMFORT 1 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08396801200","LABEL_NAME":"CA INSULIN SYR 0.3 ML 29GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08396801300","LABEL_NAME":"CA INSULIN SYR 0.5 ML 29GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08396801400","LABEL_NAME":"CA INSULIN SYR 1 ML 29GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08396801500","LABEL_NAME":"CA INS SYR 0.3 ML 30GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08396801600","LABEL_NAME":"CA INS SYR 0.5 ML 30GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08396801700","LABEL_NAME":"CA INSULIN SYR 1 ML 30GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08396801800","LABEL_NAME":"CA INS SYR 0.3 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08396801900","LABEL_NAME":"CA INS SYR 0.5 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08396802000","LABEL_NAME":"CA INSULIN SYR 1 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08418099191","LABEL_NAME":"BROOKS INSULIN 0.3ML SYRN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08439620210","LABEL_NAME":"POCKET CHAMBER","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08454000122","LABEL_NAME":"FEMCAP 22 MM CERVICAL CAP","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08454000226","LABEL_NAME":"FEMCAP 26 MM CERVICAL CAP","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08454000330","LABEL_NAME":"FEMCAP 30 MM CERVICAL CAP","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08463702930","LABEL_NAME":"LANCETS 30G","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08470027001","LABEL_NAME":"AUTOLET IMPRESS LANCING DEVICE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08470027901","LABEL_NAME":"AUTOLET LITE LANCING DEVICE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08470043501","LABEL_NAME":"UNILET COMFORTOUCH 26G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08470045501","LABEL_NAME":"UNILET GP LANCET SUPERLITE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08470046501","LABEL_NAME":"UNILET COMFORTOUCH LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08470070201","LABEL_NAME":"UNISTIK NORMAL 23G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08470071201","LABEL_NAME":"UNISTIK EXTRA 21G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08470074201","LABEL_NAME":"UNISTIK COMFORT 28G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08470075201","LABEL_NAME":"UNISTIK-2 3 MM DEVICE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08470092501","LABEL_NAME":"UNILET GP LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08470100201","LABEL_NAME":"UNISTIK 3 NORMAL 23G LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08470100701","LABEL_NAME":"UNISTIK 3 NORMAL 23G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08470100801","LABEL_NAME":"UNISTIK CZT NORMAL 23G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08470101201","LABEL_NAME":"UNISTIK 3 EXTRA 21G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08470102201","LABEL_NAME":"UNISTIK 3 GENTLE 30G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08470102801","LABEL_NAME":"UNISTIK 3 GENTLE ON-THE-GO 30G","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08470104201","LABEL_NAME":"UNISTIK 3 COMFORT 28G LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08470104801","LABEL_NAME":"UNISTIK CZT COMFORT 28G LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08470140201","LABEL_NAME":"UNISTIK TOUCH 23G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08470141201","LABEL_NAME":"UNISTIK TOUCH 21G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08470142201","LABEL_NAME":"UNISTIK SAFETY 30G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08470142401","LABEL_NAME":"UNISTIK TOUCH 30G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08470144201","LABEL_NAME":"UNISTIK SAFETY 28G LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08470144401","LABEL_NAME":"UNISTIK TOUCH 28G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08470161401","LABEL_NAME":"UNISTIK PRO 21G LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08470163401","LABEL_NAME":"UNISTIK PRO 25G LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08470164401","LABEL_NAME":"UNISTIK PRO 28G LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08484081028","LABEL_NAME":"PRODIGY TWIST TOP 28G LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08484082026","LABEL_NAME":"PRODIGY SAFETY 26G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08484990338","LABEL_NAME":"PRODIGY PRESSURE ACTIVATED 28G","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08484990355","LABEL_NAME":"PRODIGY LANCING DEVICE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08484990430","LABEL_NAME":"PRODIGY INS SYR 1ML 28GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08484990435","LABEL_NAME":"PRODIGY SYRNG 0.5 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08484990438","LABEL_NAME":"PRODIGY SYRNGE 0.3ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08489600110","LABEL_NAME":"DROPLET INS SYR 0.3 ML 31GX6MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08489600210","LABEL_NAME":"DROPLET INS 0.5ML 31GX6MM(1/2)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08489600310","LABEL_NAME":"DROPLET INS SYR 1 ML 31GX6MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08489600410","LABEL_NAME":"DROPLET INS SYR 1 ML 31GX8MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08489600510","LABEL_NAME":"DROPLET INS 0.5ML 31GX8MM(1/2)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08489600610","LABEL_NAME":"DROPLET INS SYR 0.3 ML 31GX8MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08489600710","LABEL_NAME":"DROPLET INS SYR 1ML 30GX12.5MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08489600810","LABEL_NAME":"DROPLET 0.5 ML 30GX12.5MM(1/2)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08489600910","LABEL_NAME":"DROPLET INS 0.3ML 30GX12.5MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08489601110","LABEL_NAME":"DROPLET INS SYR 1 ML 30GX8MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08489601210","LABEL_NAME":"DROPLET INS SYR 0.3 ML 30GX8MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08489601310","LABEL_NAME":"DROPLET INS 0.5ML 30GX8MM(1/2)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08489601410","LABEL_NAME":"DROPLET INS 0.5ML 30GX6MM(1/2)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08489601510","LABEL_NAME":"DROPLET INS SYR 0.3 ML 30GX6MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08489601710","LABEL_NAME":"DROPLET INS SYR 1 ML 30GX6MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08489605010","LABEL_NAME":"DROPLET INS SYR 1ML 29GX12.5MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08489605110","LABEL_NAME":"DROPLET 0.5 ML 29GX12.5MM(1/2)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08489605210","LABEL_NAME":"DROPLET INS 0.3 ML 29GX12.5MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08489704320","LABEL_NAME":"MEDLANCE PLUS LITE 25G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08489704420","LABEL_NAME":"MEDLANCE PLUS 21G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08489704520","LABEL_NAME":"MEDLANCE PLUS EXTRA 21G LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08489704620","LABEL_NAME":"MEDLANCE PLUS SPECIAL BLADE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08489715510","LABEL_NAME":"ACTI-LANCE LITE 28G LANCETS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08489715610","LABEL_NAME":"ACTI-LANCE UNIVERS 23G LANCETS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08489715710","LABEL_NAME":"ACTI-LANCE SPECIAL 17G LANCETS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08489716130","LABEL_NAME":"DROPLET 30G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08489724120","LABEL_NAME":"MEDLANCE PLUS 30G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08489915001","LABEL_NAME":"DROPLET GENTEEL LANCING DEVICE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496009501","LABEL_NAME":"EASY TOUCH FLURINGE 25GX5/8\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496009601","LABEL_NAME":"EASY TOUCH FLURINGE 1 ML 25GX1","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496010101","LABEL_NAME":"EASY TOUCH SYR 1 ML 25GX5/8\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496010201","LABEL_NAME":"EASY TOUCH SYRINGE 1 ML 25GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496011601","LABEL_NAME":"EASY TOUCH 0.5 ML SYR 29GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496011701","LABEL_NAME":"EASY TOUCH 1 ML SYR 29GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496011801","LABEL_NAME":"EASY TOUCH 0.5 ML SYR 30GX5/16","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496011901","LABEL_NAME":"EASY TOUCH 1 ML SYR 30GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496012501","LABEL_NAME":"EASY TOUCH SYRINGE 3 ML 20GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496012601","LABEL_NAME":"EASY TOUCH SYRINGE 3 ML 21GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496012701","LABEL_NAME":"EASY TOUCH SYRINGE 3 ML 22GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496012801","LABEL_NAME":"EASY TOUCH SYR 3 ML 22GX1-1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496012901","LABEL_NAME":"EASY TOUCH SYRINGE 3 ML 23GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496013001","LABEL_NAME":"EASY TOUCH SYR 3 ML 25GX5/8\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496013101","LABEL_NAME":"EASY TOUCH SYRINGE 3 ML 25GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496013501","LABEL_NAME":"EASY TOUCH SYR 26GX3/8\" 1 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496013701","LABEL_NAME":"EASY TOUCH SYR 27GX1/2\" 1 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496014001","LABEL_NAME":"EASY TOUCH FLURINGE 25GX1 1 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496015401","LABEL_NAME":"EASY TOUCH UNI-SLIP SYR 1 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496015501","LABEL_NAME":"EASY TOUCH LUER LOCK 1 ML SYR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496015801","LABEL_NAME":"EASY TOUCH UNI-SLIP 3 ML SYR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496015901","LABEL_NAME":"EASY TOUCH LUER LOCK 3 ML SYR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496016001","LABEL_NAME":"EASY TOUCH UNI-SLIP 5 ML SYR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496016101","LABEL_NAME":"EASY TOUCH LUER LOCK 5 ML SYR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496016201","LABEL_NAME":"EASY TOUCH UNI-SLIP 10 ML SYR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496016301","LABEL_NAME":"EASY TOUCH LUER LOCK 10 ML SYR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496016401","LABEL_NAME":"EASY TOUCH LUER LOK INSUL 1 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496017001","LABEL_NAME":"EASY TOUCH SHEATHLOCK 3 ML SYR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496017201","LABEL_NAME":"EASY TOUCH SHEATHLOCK 10ML SYR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496017401","LABEL_NAME":"EASY TOUCH FLURING 1ML 25GX5/8","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496018601","LABEL_NAME":"EASY TOUCH FLIPLOCK NDL 18GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496018701","LABEL_NAME":"EASY TOUCH FLIPLOK NDL 18GX1.5","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496018801","LABEL_NAME":"EASY TOUCH FLIPLOK NDL 19GX1.5","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496019001","LABEL_NAME":"EASY TOUCH FLIPLOCK NDL 19GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496019201","LABEL_NAME":"EASY TOUCH FLIPLOK NDL 20GX1.5","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496019401","LABEL_NAME":"EASY TOUCH FLIPLOCK NDL 20GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496019501","LABEL_NAME":"EASY TOUCH FLIPLOCK NDL 21GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496019601","LABEL_NAME":"EASY TOUCH FLIPLOK NDL 21GX1.5","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496019801","LABEL_NAME":"EASY TOUCH FLIPLOCK NDL 22GX1","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496019901","LABEL_NAME":"EASY TOUCH FLIPLOK NDL 22GX1.5","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496020001","LABEL_NAME":"EASY TOUCH FLIPLOK NDL 23GX5/8","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496020101","LABEL_NAME":"EASY TOUCH FLIPLOCK NDL 23GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496020201","LABEL_NAME":"EASY TOUCH FLIPLOK NDL 23GX1.5","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496020301","LABEL_NAME":"EASY TOUCH FLIPLOK NDL 25GX5/8","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496020401","LABEL_NAME":"EASY TOUCH FLIPLOCK NDL 25GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496020501","LABEL_NAME":"EASY TOUCH FLIPLOK NDL 25GX1.5","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496020601","LABEL_NAME":"EASY TOUCH FLIPLOK NDL 26GX1/2","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496020701","LABEL_NAME":"EASY TOUCH FLIPLOK NDL 27GX1/2","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496021001","LABEL_NAME":"EASY TOUCH FLIPLOK NDL 28GX1/2","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496021601","LABEL_NAME":"EASY TOUCH FLIPLOK NDL 29GX1/2","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496021701","LABEL_NAME":"EASY TOUCH FLIPLOK NDL 30GX1/2","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496021801","LABEL_NAME":"EASY TOUCH FLIPLK NDL 30GX5/16","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496021901","LABEL_NAME":"EASY TOUCH FLIPLK NDL 31GX5/16","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496022001","LABEL_NAME":"EASY TOUCH FLIPLOCK NDL 26GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496022101","LABEL_NAME":"EASY TOUCH FLIPLOCK NDL 27GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496022201","LABEL_NAME":"EASY TOUCH FLIPLOK NDL 22GX3/4","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496023101","LABEL_NAME":"EASY TOUCH TB FLP 1 ML 26GX5/8","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496023201","LABEL_NAME":"EASY TOUCH TB FLP 1 ML 28GX1/2","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496023301","LABEL_NAME":"EASY TOUCH INSULN 1ML 29GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496023401","LABEL_NAME":"EASY TOUCH INSULN 1ML 30GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496023601","LABEL_NAME":"EASY TOUCH INSULN 1ML 31GX5/16","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496024201","LABEL_NAME":"EASY TOUCH FLIPLOK 1ML 26GX3/8","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496024301","LABEL_NAME":"EASY TOUCH FLIPLOK 1ML 27GX0.5","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496024501","LABEL_NAME":"EASY TOUCH INSULN 1ML 30GX5/16","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496024601","LABEL_NAME":"EASY TOUCH FLURINGE 1 ML 25GX1","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496024801","LABEL_NAME":"EASY TOUCH FLIPLOCK 1 ML 25GX1","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496025201","LABEL_NAME":"EASY TOUCH FLIPLOCK 3 ML 18GX1","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496025301","LABEL_NAME":"EASY TOUCH FLIPLOK 3ML 18GX1.5","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496025401","LABEL_NAME":"EASY TOUCH FLIPLOCK 3 ML 19GX1","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496025501","LABEL_NAME":"EASY TOUCH FLIPLOK 3ML 19GX1.5","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496025601","LABEL_NAME":"EASY TOUCH FLIPLOCK 3 ML 20GX1","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496025701","LABEL_NAME":"EASY TOUCH FLIPLOK 3ML 20GX1.5","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496025801","LABEL_NAME":"EASY TOUCH FLIPLOCK 3 ML 21GX1","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496025901","LABEL_NAME":"EASY TOUCH FLIPLOK 3ML 21GX1.5","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496026101","LABEL_NAME":"EASY TOUCH FLIPLOCK 3 ML 22GX1","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496026201","LABEL_NAME":"EASY TOUCH FLIPLOK 3ML 22GX1.5","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496026301","LABEL_NAME":"EASY TOUCH FLIPLOCK 3 ML 23GX1","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496026401","LABEL_NAME":"EASY TOUCH FLIPLOK 3ML 25GX5/8","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496026501","LABEL_NAME":"EASY TOUCH FLIPLOCK 3 ML 25GX1","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496027401","LABEL_NAME":"EASY TOUCH FLIPLOCK 5 ML 18GX1","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496027501","LABEL_NAME":"EASY TOUCH FLIPLK 5 ML 20GX1.5","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496027601","LABEL_NAME":"EASY TOUCH FLIPLOCK SYR 20GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496027701","LABEL_NAME":"EASY TOUCH FLIPLOCK 5 ML 21GX1","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496027801","LABEL_NAME":"EASY TOUCH FLIPLK 5 ML 21GX1.5","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496028001","LABEL_NAME":"EASY TOUCH FLIPLK 5 ML 22GX1.5","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496028201","LABEL_NAME":"EASY TOUCH FLIPLK 5 ML 25GX5/8","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496028301","LABEL_NAME":"EASY TOUCH FLIPLOCK 5 ML 25GX1","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496028401","LABEL_NAME":"EASY TOUCH FLIPLK 10ML 18GX1.5","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496028501","LABEL_NAME":"EASY TOUCH FLIPLOK 10 ML 18GX1","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496028601","LABEL_NAME":"EASY TOUCH FLIPLK 10ML 20GX1.5","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496028701","LABEL_NAME":"EASY TOUCH FLIPLOK 10 ML 20GX1","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496028801","LABEL_NAME":"EASY TOUCH FLIPLK 10ML 21GX1.5","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496029001","LABEL_NAME":"EASY TOUCH FLIPLOCK 10ML 21GX1","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496029101","LABEL_NAME":"EASY TOUCH FLIPLK 10ML 22GX1.5","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496029201","LABEL_NAME":"EASY TOUCH FLIPLOK 10 ML 25GX1","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496029301","LABEL_NAME":"EASY TOUCH FLIPLOK 3ML 23GX1.5","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496030301","LABEL_NAME":"EASY TOUCH HYPODERMIC 16GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496030401","LABEL_NAME":"EASY TOUCH HYPODERMIC 16GX1.5\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496030501","LABEL_NAME":"EASY TOUCH HYPODERMIC 18GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496030601","LABEL_NAME":"EASY TOUCH HYPODERMIC 18GX1.5\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496030701","LABEL_NAME":"EASY TOUCH HYPODERMIC 18GX1.25","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496030801","LABEL_NAME":"EASY TOUCH HYPODERMIC 19GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496030901","LABEL_NAME":"EASY TOUCH HYPODERMIC 19GX1.5\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496031101","LABEL_NAME":"EASY TOUCH HYPODERMIC 20GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496031201","LABEL_NAME":"EASY TOUCH HYPODERMIC 20GX1.5\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496031301","LABEL_NAME":"EASY TOUCH HYPODERMIC 21GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496031401","LABEL_NAME":"EASY TOUCH HYPODERMIC 21GX1.5\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496031801","LABEL_NAME":"EASY TOUCH HYPODERMIC 22GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496031901","LABEL_NAME":"EASY TOUCH HYPODERMIC 22GX1.5\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496032101","LABEL_NAME":"EASY TOUCH HYPODERMIC 23GX3/4\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496032201","LABEL_NAME":"EASY TOUCH HYPODERMIC 23GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496032301","LABEL_NAME":"EASY TOUCH HYPODERMIC 23GX1.25","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496032401","LABEL_NAME":"EASY TOUCH HYPODERMIC 23GX1.5\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496032701","LABEL_NAME":"EASY TOUCH HYPODERMIC 24GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496032801","LABEL_NAME":"EASY TOUCH HYPODERMIC 24GX1.25","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496032901","LABEL_NAME":"EASY TOUCH HYPODERMIC 25GX5/8\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496033101","LABEL_NAME":"EASY TOUCH HYPODERMIC 25GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496033201","LABEL_NAME":"EASY TOUCH HYPODERMIC 25GX1.5\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496033501","LABEL_NAME":"EASY TOUCH HYPODERMIC 26GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496033701","LABEL_NAME":"EASY TOUCH HYPODERMIC 26GX3/8\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496033801","LABEL_NAME":"EASY TOUCH HYPODERMIC 26GX5/8\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496033901","LABEL_NAME":"EASY TOUCH HYPODERMIC 27GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496034001","LABEL_NAME":"EASY TOUCH HYPODERMIC 27GX1.25","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496034101","LABEL_NAME":"EASY TOUCH HYPODERMIC 27GX1.5\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496034801","LABEL_NAME":"EASY TOUCH HYPODERMIC 30GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496035001","LABEL_NAME":"EASY TOUCH HYPODERMIC 30GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496035101","LABEL_NAME":"EASY TOUCH HYPODERMIC 31GX5/16","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496035201","LABEL_NAME":"EASY TOUCH HYPODERMIC 32GX5/16","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496036301","LABEL_NAME":"EASY TOUCH FLURINGE 1 ML 25GX1","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496036401","LABEL_NAME":"EASY TOUCH FLURING 1ML 25GX5/8","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496038801","LABEL_NAME":"EASY TOUCH INSULIN 1ML 29GX1/2","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496038901","LABEL_NAME":"EASY TOUCH INSULIN 1ML 30GX1/2","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496039001","LABEL_NAME":"EASY TOUCH INSULN 1ML 31GX5/16","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496039601","LABEL_NAME":"EASY TOUCH INSULN 1ML 30GX5/16","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496039801","LABEL_NAME":"EASY TOUCH TB SHLK 1ML 25GX5/8","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496040201","LABEL_NAME":"EASY TOUCH SHEATH 3 ML 21GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496040401","LABEL_NAME":"EASY TOUCH SHEATH 3 ML 21GX1.5","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496040501","LABEL_NAME":"EASY TOUCH SHEATH 3 ML 22GX1.5","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496040601","LABEL_NAME":"EASY TOUCH SHEATH 3 ML 22GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496040701","LABEL_NAME":"EASY TOUCH SHEATH 3 ML 23GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496040801","LABEL_NAME":"EASY TOUCH SHEATH 3 ML 25GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496040901","LABEL_NAME":"EASY TOUCH SHEATH 3 ML 25GX5/8","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496042001","LABEL_NAME":"EASY TOUCH SHEATH 5 ML 21GX1.5","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496042201","LABEL_NAME":"EASY TOUCH SHEATH 5 ML 22GX1.5","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496042301","LABEL_NAME":"EASY TOUCH SHEATH 5 ML 25GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496042901","LABEL_NAME":"EASY TOUCH SHEATH 10ML 21GX1.5","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496043101","LABEL_NAME":"EASY TOUCH SHEATH 10ML 22GX1.5","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496043201","LABEL_NAME":"EASY TOUCH SHEATH 10 ML 25GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496043401","LABEL_NAME":"EASY TOUCH TB SHLK 1ML 28GX1/2","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496044501","LABEL_NAME":"EASY TOUCH TB SHLK 1ML 26GX5/8","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496044601","LABEL_NAME":"EASY TOUCH TB SHLK 1ML 27GX1/2","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496044701","LABEL_NAME":"EASY TOUCH TB FLP 1 ML 27GX1/2","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496080801","LABEL_NAME":"EASY TOUCH LANCING DEVICE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496212201","LABEL_NAME":"EASY TOUCH SAFETY 21G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496231801","LABEL_NAME":"EASY TOUCH SAFETY 23G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496260801","LABEL_NAME":"EASY TOUCH SAFETY 26G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496261001","LABEL_NAME":"EASY TOUCH TWIST 26G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496261201","LABEL_NAME":"EASY TOUCH PULL-TOP 26G LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496271501","LABEL_NAME":"EASY TOUCH 1 ML SYR 27GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496275501","LABEL_NAME":"EASY TOUCH 0.5 ML SYR 27GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496280801","LABEL_NAME":"EASY TOUCH SAFETY 28G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496281001","LABEL_NAME":"EASY TOUCH TWIST 28G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496281201","LABEL_NAME":"EASY TOUCH PULL-TOP 28G LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496281501","LABEL_NAME":"EASY TOUCH INSULIN SYR 1 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496285501","LABEL_NAME":"EASY TOUCH INSULIN SYR 0.5 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496290201","LABEL_NAME":"EASY TOUCH PEN NEEDLE 29GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496300501","LABEL_NAME":"EASY TOUCH PEN NEEDLE 30GX5/16","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496300601","LABEL_NAME":"EASY TOUCH SAFETY 30G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496301001","LABEL_NAME":"EASY TOUCH TWIST 30G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496301201","LABEL_NAME":"EASY TOUCH PULL-TOP 30G LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496301501","LABEL_NAME":"EASY TOUCH 1 ML SYR 30GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496303501","LABEL_NAME":"EASY TOUCH 0.3 ML SYR 30GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496303601","LABEL_NAME":"EASY TOUCH INSULIN SYR 0.3 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496305501","LABEL_NAME":"EASY TOUCH 0.5 ML SYR 30GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496310101","LABEL_NAME":"EASY TOUCH PEN NEEDLE 31GX3/16","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496310401","LABEL_NAME":"EASY TOUCH PEN NEEDLE 31GX1/4\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496310601","LABEL_NAME":"EASY TOUCH PEN NEEDLE 31GX5/16","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496311601","LABEL_NAME":"EASY-TOUCH INS 1 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496320101","LABEL_NAME":"EASY TOUCH PEN NEEDLE 32GX3/16","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496320401","LABEL_NAME":"EASY TOUCH PEN NEEDLE 32GX1/4\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496320601","LABEL_NAME":"EASY TOUCH SAFETY 32G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496320801","LABEL_NAME":"EASY TOUCH PEN NEEDLE 32GX5/32","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496321001","LABEL_NAME":"EASY TOUCH TWIST 32G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496321201","LABEL_NAME":"EASY TOUCH PULL-TOP 32G LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496331001","LABEL_NAME":"EASY TOUCH TWIST 33G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08496651001","LABEL_NAME":"EASY TOUCH SYR 1 ML 27G 12.7MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496651101","LABEL_NAME":"EASY TOUCH SYR 1 ML 28G 12.7MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496651201","LABEL_NAME":"EASY TOUCH SYR 1 ML 29G 12.7MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496652001","LABEL_NAME":"EASY TOUCH SYR 0.5ML 27G12.7MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496652101","LABEL_NAME":"EASY TOUCH SYR 0.5ML 28G12.7MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496652201","LABEL_NAME":"EASY TOUCH SYR 0.5ML 29G12.7MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08496702001","LABEL_NAME":"EASY TOUCH SYR 1 ML 27G 16MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08508200005","LABEL_NAME":"OMNIPOD DASH PODS (GEN 4) 5PK","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08508200032","LABEL_NAME":"OMNIPOD DASH INTRO KIT (GEN 4)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08508300001","LABEL_NAME":"OMNIPOD 5 DEXG7G6 INTRO(GEN 5)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08508300021","LABEL_NAME":"OMNIPOD 5 DEXG7G6 PODS (GEN 5)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08508300042","LABEL_NAME":"OMNIPOD 5 (G6/LIBRE 2 PLUS)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08508300088","LABEL_NAME":"OMNIPOD 5 INTRO(G6/LIBRE2PLUS)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08522000050","LABEL_NAME":"VANTAGE LANCING DEVICE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08524000403","LABEL_NAME":"SMARTEST LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08525010300","LABEL_NAME":"GLUCOCOM 28G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08525011200","LABEL_NAME":"GLUCOCOM 30G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08525011300","LABEL_NAME":"GLUCOCOM 33G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08539002001","LABEL_NAME":"RIGHTEST GD500 LANCING DEVICE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08539060000","LABEL_NAME":"RIGHTEST GL300 30G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08539900400","LABEL_NAME":"GE LANCING DEVICE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08548043447","LABEL_NAME":"NOVA SUREFLEX LANCING DEVICE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08548048738","LABEL_NAME":"NOVA SUREFLEX THIN LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08548050938","LABEL_NAME":"NOVA SAFETY 28G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08548050939","LABEL_NAME":"NOVA SAFETY 23G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08554197101","LABEL_NAME":"AGAMATRIX ULTRA-THIN 33G LANCT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08560940001","LABEL_NAME":"V-GO 40 DISPOSABLE DEVICE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08560940002","LABEL_NAME":"V-GO 30 DISPOSABLE DEVICE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08560940003","LABEL_NAME":"V-GO 20 DISPOSABLE DEVICE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08565015915","LABEL_NAME":"TWIST LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08565016915","LABEL_NAME":"STERILANCE TL TWIST 30G LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08565017915","LABEL_NAME":"STERILANCE TL TWIST 32G LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08565044415","LABEL_NAME":"LANCETS 26G X 1.8MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08591601001","LABEL_NAME":"RITEFLO SPACER","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08593211402","LABEL_NAME":"ULTRALANCE 26G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08593211502","LABEL_NAME":"ULTRALANCE 28G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08595000000","LABEL_NAME":"SAFESNAP SYRINGE 3 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08595000050","LABEL_NAME":"SAFESNAP SYRINGE 5 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08595013001","LABEL_NAME":"SAFESNAP INSUL SYRINGE 0.3 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08595022901","LABEL_NAME":"SAFESNAP INSUL SYRINGE 0.5 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08595032801","LABEL_NAME":"SAFESNAP INSULIN SYRINGE 1 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08595042500","LABEL_NAME":"SAFESNAP TUBERCULIN SYR 1 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08595052700","LABEL_NAME":"SAFESNAP ALLERGY SYRINGE 1 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08595060000","LABEL_NAME":"SAFESNAP SYRINGE 3 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08595070050","LABEL_NAME":"SAFESNAP SYRINGE 5 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08595070350","LABEL_NAME":"SAFESNAP SYRINGE 5 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08595080050","LABEL_NAME":"SAFESNAP SYRINGE 10 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08595080150","LABEL_NAME":"SAFESNAP SYRINGE 10 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08611504000","LABEL_NAME":"SOLUS V2 30G TWIST LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08611504100","LABEL_NAME":"SOLUS V2 28G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08611505001","LABEL_NAME":"SOLUS V2 LANCING DEVICE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08618000009","LABEL_NAME":"INVACARE LANCING DEVICE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08618003001","LABEL_NAME":"INVACARE 30G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08620136025","LABEL_NAME":"CHEK-STIX STRIPS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08620216121","LABEL_NAME":"MULTISTIX 10 SG REAGENT STRIPS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08620216221","LABEL_NAME":"MULTISTIX 9 REAGENT STRIPS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08620216321","LABEL_NAME":"MULTISTIX 9 SG REAGENT STRIPS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08620216421","LABEL_NAME":"MULTISTIX 8 SG REAGENT STRIPS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08620216521","LABEL_NAME":"MULTISTIX 7 REAGENT STRIPS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08620216621","LABEL_NAME":"URISTIX 4 REAGENT STRIPS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08620217921","LABEL_NAME":"MULTISTIX REAGENT STRIPS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08620218121","LABEL_NAME":"LABSTIX REAGENT STRIPS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08620218221","LABEL_NAME":"HEMA-COMBISTIX REAGENT STRIPS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08620218321","LABEL_NAME":"COMBISTIX REAGENT STRIPS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08620218421","LABEL_NAME":"URISTIX REAGENT STRIPS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08620230921","LABEL_NAME":"MULTISTIX 5 STRIPS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08627001601","LABEL_NAME":"DEXCOM G6 TRANSMITTER","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":true,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08627005303","LABEL_NAME":"DEXCOM G6 SENSOR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":true,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08627007701","LABEL_NAME":"DEXCOM G7 SENSOR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":true,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08627007801","LABEL_NAME":"DEXCOM G7 RECEIVER","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":true,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08627007901","LABEL_NAME":"DEXCOM G7 15 DAY SENSOR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":true,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08627009111","LABEL_NAME":"DEXCOM G6 RECEIVER","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":true,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08633900001","LABEL_NAME":"DROPLET LANCING DEVICE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08638715610","LABEL_NAME":"ACTI-LANCE UNIVERS 23G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08881103025","LABEL_NAME":"SYRINGE W-O NDL 3 ML NON-STRL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08881106028","LABEL_NAME":"SYRINGE W-O NDL 6 ML NON-STRL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08881200011","LABEL_NAME":"HYPODERMIC NEEDLE,ALUM HUB","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08881250016","LABEL_NAME":"HYPO NEEDLE,POLYPROPYL HUB","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08881500014","LABEL_NAME":"MONOJECT INSUL SYR U100 0.5 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08881500105","LABEL_NAME":"TUBERCULIN SYRINGES","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08881500501","LABEL_NAME":"ALLERGIST SYR 28GX1/2\" 0.5 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08881501160","LABEL_NAME":"MONOJECT TB SYRN 25GX5/8\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08881501178","LABEL_NAME":"MONOJECT TB SYRN 26GX3/8\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08881501236","LABEL_NAME":"ALLERGY TRAY SYR 28GX1/2\" 1 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08881501368","LABEL_NAME":"MONOJECT TB SYRN 27GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08881501384","LABEL_NAME":"MONOJECT INSUL SYR U100 1 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08881501608","LABEL_NAME":"TUBERCULIN SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08881501962","LABEL_NAME":"ALLERGIST SYR 27GX1/2\" 1 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08881511110","LABEL_NAME":"MONOJECT INSULIN SYR U-100","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08881511136","LABEL_NAME":"MONOJECT INSULIN SYR U-100","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08881511144","LABEL_NAME":"MONOJECT INSULIN SYRN 3/10 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08881511201","LABEL_NAME":"MONOJECT TB SAFE 1 ML 28G 13MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08881511235","LABEL_NAME":"MONOJECT TB SAFETY SYRN 1 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08881511310","LABEL_NAME":"MONOJECT INSULIN SYR 1 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08881511336","LABEL_NAME":"MONOJECT INSULIN SYR 0.5 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08881511344","LABEL_NAME":"MONOJECT INSULIN SYR 0.3 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08881513025","LABEL_NAME":"MONOJECT SYRN 3 ML 20GX3/4\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08881513033","LABEL_NAME":"MONOJECT SYRNG 20GX1\" 3 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08881513132","LABEL_NAME":"MONOJECT 3 ML SYRN 21GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08881513157","LABEL_NAME":"MONOJECT 3 ML SYRN 21GX11/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08881513207","LABEL_NAME":"MONOJECT SYR PHARM TRAY PK","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08881513231","LABEL_NAME":"MONOJECT SYRINGE 3 ML 22G 1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08881513256","LABEL_NAME":"MONOJECT 3 ML SYRN 22GX11/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08881513330","LABEL_NAME":"MONOJECT 3 ML SYRN 23GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08881513538","LABEL_NAME":"MONOJECT 3 ML SYRN 25GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08881513744","LABEL_NAME":"MONOJECT 3 ML SYRN 27GX11/4\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08881513918","LABEL_NAME":"MONOJECT 3 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08881516200","LABEL_NAME":"MONOJECT SYR PHARM TRAY PK","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08881516911","LABEL_NAME":"MONOJECT 6 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08881533130","LABEL_NAME":"SAFETY SYRINGE W-SHIELD 3 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08881533908","LABEL_NAME":"MONOJECT SAFETY SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08881600145","LABEL_NAME":"MONOJECT INSUL SYR U100","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08881600350","LABEL_NAME":"MONOJECT INSUL SYR U100","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08881602075","LABEL_NAME":"MONOLET 21G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08881602141","LABEL_NAME":"MONOLET THIN 28G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08881609004","LABEL_NAME":"ULTRA COMFORT 0.5 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08881609101","LABEL_NAME":"ULTRA COMFORT 1 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08881609145","LABEL_NAME":"ULTRA COMFORT 0.3 ML 29GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08881609231","LABEL_NAME":"MONOJECT SYRINGE 0.5 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08881609331","LABEL_NAME":"MONOJECT SYRINGE 0.3 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08881609800","LABEL_NAME":"ULTRA COMFORT 0.3 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08881811310","LABEL_NAME":"MONOJECT MAGELLAN SYRINGE 1 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08881833010","LABEL_NAME":"MONOJECT MAGELLAN SYRINGE 3 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08881882712","LABEL_NAME":"MAGELLAN TUBERCULIN SYR 1 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08881882812","LABEL_NAME":"MAGELLAN TB SAFE 1 ML 28GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08881892910","LABEL_NAME":"MAGELLAN INSULIN SYRINGE 1 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08881892930","LABEL_NAME":"MAGELLAN INSULIN SYR 0.3 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08881892950","LABEL_NAME":"MAGELLAN INSULIN SYR 0.5 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08881893030","LABEL_NAME":"MAGELLAN INSUL SYRINGE 0.3 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08881893050","LABEL_NAME":"MAGELLAN INSUL SYRINGE 0.5 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08970100160","LABEL_NAME":"TERUMO INS SYRINGE U100-1/3 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08970100161","LABEL_NAME":"TERUMO INS SYRINGE U100-1/2 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08970100635","LABEL_NAME":"TERUMO SURGUARD2 NEEDLE 18GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08970100636","LABEL_NAME":"TERUMO SURGUARD2 NEEDLE 18X1.5","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08970100637","LABEL_NAME":"TERUMO SURGUARD2 NEEDLE 19GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08970100638","LABEL_NAME":"TERUMO SURGUARD2 NEEDLE 19X1.5","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08970100639","LABEL_NAME":"TERUMO SURGUARD2 NEEDLE 20GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08970100640","LABEL_NAME":"TERUMO SURGUARD2 NEEDLE 20X1.5","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08970100641","LABEL_NAME":"TERUMO SURGUARD2 NEEDLE 21GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08970100642","LABEL_NAME":"TERUMO SURGUARD2 NDL 21GX1 1.5","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08970100643","LABEL_NAME":"TERUMO SURGUARD2 NEEDLE 22GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08970100644","LABEL_NAME":"TERUMO SURGUARD2 NDL 22X1-1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08970100645","LABEL_NAME":"TERUMO SURGUARD2 NEEDLE 23GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08970100646","LABEL_NAME":"TERUMO SURGUARD2 NDL 23X1-1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08970100647","LABEL_NAME":"TERUMO SURGUARD2 NEEDLE 25X5/8","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08970100648","LABEL_NAME":"TERUMO SURGUARD2 NEEDLE 25GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08970100649","LABEL_NAME":"TERUMO SURGUARD2 NEEDLE 25X1.5","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08970100650","LABEL_NAME":"TERUMO SURGUARD2 NEEDLE 26X1/2","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08970100651","LABEL_NAME":"TERUMO SURGUARD2 NEEDLE 27X1/2","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08970100652","LABEL_NAME":"TERUMO SURGUARD2 NEEDLE 30X1/2","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08970100653","LABEL_NAME":"TERUMO SURGUARD2 SYR 25G-1 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08970100654","LABEL_NAME":"TERUMO SURGUARD2 SYR 26G-1 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08970100655","LABEL_NAME":"TERUMO SURGUARD2 SYR 27G-1 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08970100656","LABEL_NAME":"TERUMO SURGUARD2 SYR 20G-3 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08970100658","LABEL_NAME":"TERUMO SURGUARD2 SYR 21G-3 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08970100659","LABEL_NAME":"TERUMO SURGUARD2 SYR 21G 3 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08970100660","LABEL_NAME":"TERUMO SURGUARD2 SYR 22G 3 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08970100662","LABEL_NAME":"TERUMO SURGUARD2 SYR 23G 3 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08970100663","LABEL_NAME":"TERUMO SURGUARD2 SYR 25G 3 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08970100665","LABEL_NAME":"TERUMO SURGUARD2 SYR 20G-5 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08970100667","LABEL_NAME":"TERUMO SURGUARD2 SYR 21G-5 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08970100668","LABEL_NAME":"TERUMO SURGUARD2 SYR 20G-10 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08970100670","LABEL_NAME":"TERUMO SURGUARD2 SYR 21G-10 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08970100827","LABEL_NAME":"TERUMO INS SYRINGE U100-1 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08970100861","LABEL_NAME":"THINPRO INS SYRIN U100-0.3 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08970100863","LABEL_NAME":"THINPRO INS SYRIN U100-1 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08970100864","LABEL_NAME":"THINPRO INS SYRIN U100-0.5 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08970100871","LABEL_NAME":"THINPRO INS SYRIN U100-0.3 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08970100872","LABEL_NAME":"THINPRO INS SYRIN U100-0.5 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08970100873","LABEL_NAME":"THINPRO INS SYRIN U100-1 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08970200521","LABEL_NAME":"TERUMO INS SYRNG U100-1/2 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08970201021","LABEL_NAME":"TERUMO INS SYRINGE U100-1 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08970203031","LABEL_NAME":"TERUMO INS SYR 0.3 ML 29GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"08970501021","LABEL_NAME":"TERUMO ALLERGY 1 ML 27GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08970721111","LABEL_NAME":"TERUMO SYRINGE 3 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"08970731001","LABEL_NAME":"TERUMO HYPODERMIC NDL-SYRIN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"10019098401","LABEL_NAME":"CYCLOPHOSPHAMIDE 50 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10118089032","LABEL_NAME":"AQ INSULIN SYR 0.5 ML 30G 8MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10118089036","LABEL_NAME":"AQ INSULIN SYRIN 1 ML 29G 12MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10118089040","LABEL_NAME":"AQ INSULIN SYR 1 ML 31G 8MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10122010150","LABEL_NAME":"FERRIPROX 100 MG/ML SOLUTION","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10122021002","LABEL_NAME":"MYALEPT 11.3 MG (5 MG/ML) VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10122031001","LABEL_NAME":"FILSUVEZ 10% GEL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10122040528","LABEL_NAME":"JUXTAPID 5 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10122041028","LABEL_NAME":"JUXTAPID 10 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10122042028","LABEL_NAME":"JUXTAPID 20 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10122043028","LABEL_NAME":"JUXTAPID 30 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10122050201","LABEL_NAME":"REVCOVI 2.4 MG/1.5 ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10122055028","LABEL_NAME":"MYCAPSSA DR 20 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10135011901","LABEL_NAME":"PYRIDOXINE 25 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"10135013910","LABEL_NAME":"PYRIDOXINE 50 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"10135014614","LABEL_NAME":"SODIUM POLYSTYRENE SULF POWDER","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10135014901","LABEL_NAME":"DIPHENHYDRAMINE 25 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"10135018001","LABEL_NAME":"FOLIC ACID 0.4 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"10135018101","LABEL_NAME":"FOLIC ACID 0.8 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"10135024036","LABEL_NAME":"CHILD ASPIRIN 81 MG TAB CHEW","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"10135040401","LABEL_NAME":"SALSALATE 750 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10135049201","LABEL_NAME":"SALSALATE 500 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10135053901","LABEL_NAME":"DOXYCYCLINE HYCLATE 20 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10135056919","LABEL_NAME":"CLINDAMYCIN (PEDI) 75 MG/5 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10135058401","LABEL_NAME":"ISONIAZID 300 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10135060190","LABEL_NAME":"FELBAMATE 400 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10135060290","LABEL_NAME":"FELBAMATE 600 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10135060571","LABEL_NAME":"LAMIVUDINE 10 MG/ML ORAL SOLN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10135061001","LABEL_NAME":"OXYBUTYNIN CL ER 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10135061101","LABEL_NAME":"OXYBUTYNIN CL ER 15 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10135061530","LABEL_NAME":"ENTECAVIR 0.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10135061630","LABEL_NAME":"ENTECAVIR 1 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10135062001","LABEL_NAME":"PHENAZOPYRIDINE 100 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10135062101","LABEL_NAME":"PHENAZOPYRIDINE 200 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10135062301","LABEL_NAME":"BETAXOLOL 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10135062401","LABEL_NAME":"BETAXOLOL 20 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10135062501","LABEL_NAME":"DEMECLOCYCLINE 150 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10135062648","LABEL_NAME":"DEMECLOCYCLINE 300 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10135063001","LABEL_NAME":"ACEBUTOLOL 200 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10135063101","LABEL_NAME":"ACEBUTOLOL 400 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10135063205","LABEL_NAME":"BENZONATATE 200 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10135065401","LABEL_NAME":"DAPSONE 25 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10135067401","LABEL_NAME":"ROPINIROLE HCL 0.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10135067601","LABEL_NAME":"ROPINIROLE HCL 2 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10135067701","LABEL_NAME":"ROPINIROLE HCL 3 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10135067801","LABEL_NAME":"ROPINIROLE HCL 4 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10135067901","LABEL_NAME":"ROPINIROLE HCL 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10135068230","LABEL_NAME":"GUAIFENESIN 400 MG CAPLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"10135068601","LABEL_NAME":"NADOLOL 20 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10135068701","LABEL_NAME":"NADOLOL 40 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10135068801","LABEL_NAME":"NADOLOL 80 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10135069201","LABEL_NAME":"AMANTADINE 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10135069461","LABEL_NAME":"SERTRALINE 20 MG/ML ORAL CONC","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10135069712","LABEL_NAME":"ALENDRONATE SODIUM 70 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10135071812","LABEL_NAME":"ALENDRONATE SODIUM 35 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10135072085","LABEL_NAME":"ANTIFUNGAL 2% POWDER","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"10135073760","LABEL_NAME":"SELEGILINE HCL 5 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10135073801","LABEL_NAME":"RIFABUTIN 150 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10135074301","LABEL_NAME":"PINDOLOL 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10135074401","LABEL_NAME":"PINDOLOL 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10135074560","LABEL_NAME":"MISOPROSTOL 100 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10135074660","LABEL_NAME":"MISOPROSTOL 200 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10135077201","LABEL_NAME":"ACETAZOLAMIDE 125 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10135079601","LABEL_NAME":"ETHAMBUTOL HCL 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10135079701","LABEL_NAME":"ETHAMBUTOL HCL 400 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10135079841","LABEL_NAME":"OXCARBAZEPINE 300 MG/5 ML SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10135080401","LABEL_NAME":"ISONIAZID 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10135082305","LABEL_NAME":"METFORMIN HCL ER 500 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10135082405","LABEL_NAME":"METFORMIN HCL ER 750 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10144034260","LABEL_NAME":"INBRIJA 42 MG INHALATION CAP","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10147057001","LABEL_NAME":"ETRAVIRINE 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10147057101","LABEL_NAME":"ETRAVIRINE 200 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10147170003","LABEL_NAME":"ITRACONAZOLE 100 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10148020115","LABEL_NAME":"MIGLUSTAT 100 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10370028009","LABEL_NAME":"DUTASTERIDE-TAMSULOSIN 0.5-0.4","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10454071010","LABEL_NAME":"MYOBLOC 2,500 UNIT/0.5 ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10454071110","LABEL_NAME":"MYOBLOC 5,000 UNITS/1 ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10454071210","LABEL_NAME":"MYOBLOC 10,000 UNITS/2 ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10542007010","LABEL_NAME":"DIALYVITE 800 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"10572010001","LABEL_NAME":"PEG-3350 AND ELECTROLYTES SOLN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10572030201","LABEL_NAME":"PEG 3350-ELECTROLYTE SOLUTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10631040701","LABEL_NAME":"PROCTOSOL-HC 2.5% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10702001601","LABEL_NAME":"INDOMETHACIN ER 75 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10702002301","LABEL_NAME":"OXYCODONE HCL (IR) 5 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10702005501","LABEL_NAME":"HYDROCODONE-HOMATROPINE 5-1.5","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10702010601","LABEL_NAME":"DEXMETHYLPHENIDATE 2.5 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10702010701","LABEL_NAME":"DEXMETHYLPHENIDATE 5 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10702010801","LABEL_NAME":"DEXMETHYLPHENIDATE 10 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10702015016","LABEL_NAME":"HYDROCODONE-HOMATROPINE SOLN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10702017001","LABEL_NAME":"DESMOPRESSIN ACETATE 0.2 MG TB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10702018401","LABEL_NAME":"OXYCODONE-ACETAMINOPHN 2.5-325","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"10939000644","LABEL_NAME":"SM CHEST CONGESTION 400MG CPLT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"10939027533","LABEL_NAME":"SM CHILD ASPIRIN 81 MG CHW TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"10939035933","LABEL_NAME":"SM IBUPROFEN 200 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"10939038033","LABEL_NAME":"SM MICONAZOLE 2% VAGINAL CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"10939057233","LABEL_NAME":"SM HYDROCORTISONE 1% OINTMENT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"10939057433","LABEL_NAME":"SM MICONAZOLE 2% TOPICAL CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"10939095585","LABEL_NAME":"FT SALINE 0.65% NASAL SPRAY","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"10939095708","LABEL_NAME":"FT PRENATAL TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"10939095714","LABEL_NAME":"FT VITAMIN B-6 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"10939095744","LABEL_NAME":"FT FOLIC ACID 400 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"10939095745","LABEL_NAME":"FT FOLIC ACID 800 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"10956061801","LABEL_NAME":"REESE'S PINWORM 144 MG/ML SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"10956078850","LABEL_NAME":"REFENESEN 400 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"11026262903","LABEL_NAME":"OBSTETRIX DHA COMBO PAK","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"11423000329","LABEL_NAME":"REPEL SPORTSMEN 29% SPRAY","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"11423000338","LABEL_NAME":"REPEL SPORTSMEN MAX 40% SPRAY","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"11423000402","LABEL_NAME":"REPEL 100 98.11% SPRAY","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"11423094079","LABEL_NAME":"REPEL SPORTSMEN MAX 40% LOTION","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"11423094095","LABEL_NAME":"REPEL SPORTSMEN MAX 40% SPRAY","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"11423094100","LABEL_NAME":"REPEL 30% WIPE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"11423094109","LABEL_NAME":"REPEL LEMON EUCALYPTUS 30% SPR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"11423094120","LABEL_NAME":"REPEL FAMILY 10% SPRAY","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"11423094133","LABEL_NAME":"REPEL SPORTSMEN DRY 25% SPRAY","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"11423094136","LABEL_NAME":"REPEL FAMILY 15% SPRAY","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"11423094137","LABEL_NAME":"REPEL SPORTSMEN 25% SPRAY","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"11423094138","LABEL_NAME":"REPEL TICK DEFENSE 15% SPRAY","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"11423094139","LABEL_NAME":"REPEL HUNTER'S 25% SPRAY","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"11527070442","LABEL_NAME":"SODIUM FLUORIDE SENSTV 5000PPM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"11527073044","LABEL_NAME":"SODIUM FLUORIDE 5000 PPM PASTE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"11527074534","LABEL_NAME":"SOD FLUORIDE ENAM PROT 5000PPM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"11527075534","LABEL_NAME":"SODIUM FLUORIDE 5000 DRY MOUTH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"11584003001","LABEL_NAME":"TENCON 50-325 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"11673010526","LABEL_NAME":"ACETAMINOPHEN 160 MG/5 ML SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"11673030602","LABEL_NAME":"POWDERLAX POWDER","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"11673030603","LABEL_NAME":"POWDERLAX POWDER","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"11673030652","LABEL_NAME":"POWDERLAX 17 G POWDER PACKET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"11673046278","LABEL_NAME":"ALLERGY RELIEF 25 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"11673088426","LABEL_NAME":"CHILD ALL DAY ALLERGY 1 MG/ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"11701006714","LABEL_NAME":"CRITIC-AID CLEAR AF 2% OINT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"11788004601","LABEL_NAME":"MELOXICAM 7.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"11788004701","LABEL_NAME":"MELOXICAM 15 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"11788011607","LABEL_NAME":"SEVELAMER CARBONATE 800 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"11797011001","LABEL_NAME":"DUVYZAT 8.86 MG/ML ORAL SUSP","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"11917001006","LABEL_NAME":"GLYCERIN ADULT SUPPOSITORY","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"11917001487","LABEL_NAME":"INSULIN 1 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"11917001489","LABEL_NAME":"INSULIN 1/2 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"11917001492","LABEL_NAME":"INSULIN 3/10 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"11917002536","LABEL_NAME":"INSULIN SYRIN 0.5 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"11917003586","LABEL_NAME":"CLOTRIMAZOLE-3 2% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"11917004416","LABEL_NAME":"VITAMIN B-COMPLEX & C CAPLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"11917004813","LABEL_NAME":"INSULIN SYRINGE 1 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"11917004815","LABEL_NAME":"INSULIN SYRIN 0.3 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"11917005003","LABEL_NAME":"WAL-PROFEN 200 MG SOFTGEL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"11917005004","LABEL_NAME":"WAL-PROFEN 200 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"11917005880","LABEL_NAME":"PRENATAL TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"11917006546","LABEL_NAME":"VITAMIN B-COMPLEX & C CAPLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"11917007404","LABEL_NAME":"PRENATAL TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"11917007696","LABEL_NAME":"PRENATAL COMPLETE CAPLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"11917007873","LABEL_NAME":"ATHLETES FOOT 1% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"11917010653","LABEL_NAME":"PHOSPHATE ORAL SALINE LAXATIVE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"11917011815","LABEL_NAME":"SUPER THIN 28G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"11917011828","LABEL_NAME":"ADVANCED TRAVEL 28G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"11917012480","LABEL_NAME":"CHILD PAIN REL-FEVER 120MG SUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"11917013229","LABEL_NAME":"INFANTS PAIN-FEVER 160 MG/5 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"11917013374","LABEL_NAME":"BALANCED B-COMPLEX CAPLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"11917013415","LABEL_NAME":"TRUEPLUS SUPER THIN 28G LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"11917013417","LABEL_NAME":"TRUEPLUS ULTRA THIN 30G LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"11917013858","LABEL_NAME":"B-COMPLEX WITH VIT C CAPLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"11917014837","LABEL_NAME":"ARTHRITIS PAIN ER 650 MG GELTB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"11917015670","LABEL_NAME":"PRENATAL MULTI-DHA SOFTGEL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"11917016787","LABEL_NAME":"ATHLETE'S FOOT 2% POWDER","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"11917017067","LABEL_NAME":"B-COMPLEX WITH VIT C TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"11917017102","LABEL_NAME":"PRENATAL MULTIVITAMIN TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"11917017127","LABEL_NAME":"PRENATAL MULTIVITAMIN TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"11917018202","LABEL_NAME":"24 HOUR ALLERGY 50 MCG SPRAY","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"11917018294","LABEL_NAME":"PINWORM MEDICINE 144 MG/ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"11917018877","LABEL_NAME":"MOBILE 30G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"11917021708","LABEL_NAME":"STERILE 33G LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"12496000301","LABEL_NAME":"OPVEE 2.7 MG NASAL SPRAY","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"12496010001","LABEL_NAME":"SUBLOCADE 100 MG/0.5 ML SYRING","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"12496030001","LABEL_NAME":"SUBLOCADE 300 MG/1.5 ML SYRING","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"12608003001","LABEL_NAME":"ONETOUCH DELICA PLUS 33G LANCT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"12608003002","LABEL_NAME":"ONETOUCH DELICA PLUS 30G LANCT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"12608003005","LABEL_NAME":"ONETOUCH DELICA PLUS LANC DEV","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"13107000105","LABEL_NAME":"MIRTAZAPINE 7.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13107000401","LABEL_NAME":"HYDROCODONE-IBUPROFEN 7.5-200","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13107001501","LABEL_NAME":"GLYCOPYRROLATE 2 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13107028201","LABEL_NAME":"CLORAZEPATE 3.75 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13107028301","LABEL_NAME":"CLORAZEPATE 7.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13107028401","LABEL_NAME":"CLORAZEPATE 15 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13273010803","LABEL_NAME":"HYOSCYAMINE SULF 0.125 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13517020716","LABEL_NAME":"PHENOBARBITAL 20 MG/5 ML ELIX","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13551000107","LABEL_NAME":"LUMRYZ ER 4.5 GM PACKET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13551000207","LABEL_NAME":"LUMRYZ ER 6 GM PACKET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13551000307","LABEL_NAME":"LUMRYZ ER 7.5 GM PACKET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13551000407","LABEL_NAME":"LUMRYZ ER 9 GM PACKET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13551000501","LABEL_NAME":"LUMRYZ 4.5-6-7.5 GM STARTER PK","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13668004801","LABEL_NAME":"LAMOTRIGINE 150 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13668004905","LABEL_NAME":"LAMOTRIGINE 200 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13668007905","LABEL_NAME":"MONTELUKAST SOD 4 MG TAB CHEW","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13668008005","LABEL_NAME":"MONTELUKAST SOD 5 MG TAB CHEW","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13668009405","LABEL_NAME":"PRAMIPEXOLE 1 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13668010601","LABEL_NAME":"ISOSORBIDE MONONIT ER 120 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13668010730","LABEL_NAME":"RABEPRAZOLE SOD DR 20 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13668013501","LABEL_NAME":"ESCITALOPRAM 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13668017905","LABEL_NAME":"ROSUVASTATIN CALCIUM 5 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13668018005","LABEL_NAME":"ROSUVASTATIN CALCIUM 10 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13668018105","LABEL_NAME":"ROSUVASTATIN CALCIUM 20 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13668018205","LABEL_NAME":"ROSUVASTATIN CALCIUM 40 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13668020230","LABEL_NAME":"DARIFENACIN ER 7.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13668020330","LABEL_NAME":"DARIFENACIN ER 15 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13668031230","LABEL_NAME":"AMLODIPINE-OLMESARTAN 10-20 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13668035630","LABEL_NAME":"NEBIVOLOL 20 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13668043801","LABEL_NAME":"FENOFIBRATE 200 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13668043901","LABEL_NAME":"FENOFIBRATE 134 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13668044001","LABEL_NAME":"FENOFIBRATE 67 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13668045301","LABEL_NAME":"ANAGRELIDE HCL 0.5 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13668046201","LABEL_NAME":"ANAGRELIDE HCL 1 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13668048301","LABEL_NAME":"MINOCYCLINE 75 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13668051501","LABEL_NAME":"ACYCLOVIR 5% OINTMENT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13668053111","LABEL_NAME":"MONTELUKAST SOD 4 MG GRANULES","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13668053830","LABEL_NAME":"ESLICARBAZEPINE 200 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13668053930","LABEL_NAME":"ESLICARBAZEPINE 400 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13668054060","LABEL_NAME":"ESLICARBAZEPINE 600 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13668054130","LABEL_NAME":"ESLICARBAZEPINE 800 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13668054694","LABEL_NAME":"ESOMEPRAZOLE DR 2.5 MG PACKET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13668054794","LABEL_NAME":"ESOMEPRAZOLE DR 5 MG PACKET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13668054894","LABEL_NAME":"ESOMEPRAZOLE DR 10 MG PACKET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13668054994","LABEL_NAME":"ESOMEPRAZOLE DR 20 MG PACKET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13668055088","LABEL_NAME":"ESOMEPRAZOLE DR 40 MG PACKET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13668058130","LABEL_NAME":"TADALAFIL 20 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13668058601","LABEL_NAME":"ERYTHROMYCIN DR 250 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13668058730","LABEL_NAME":"ERYTHROMYCIN DR 333 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13668058801","LABEL_NAME":"ERYTHROMYCIN DR 500 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13668067601","LABEL_NAME":"DICHLORPHENAMIDE 50 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13668071057","LABEL_NAME":"NILOTINIB HCL 150 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13668071157","LABEL_NAME":"NILOTINIB HCL 200 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13703010130","LABEL_NAME":"VANISHPOINT 1 ML TB SYR 27X1/2","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"13703010150","LABEL_NAME":"VANISHPOINT 1 ML TB SYR 25X5/8","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"13703010160","LABEL_NAME":"VANISHPOINT SYRINGE 1 ML 25X1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"13703010161","LABEL_NAME":"SYRINGE W-NEEDLE 1 ML 25X1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"13703010210","LABEL_NAME":"VANISHPOINT U-100 29X1/2 SYR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13703010291","LABEL_NAME":"VANISHPOINT INS 1 ML 30GX3/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13703010300","LABEL_NAME":"VANISHPOINT 25GX5/8\" 3 ML SYR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"13703010310","LABEL_NAME":"VANISHPOINT 23GX1\" 3 ML SYRING","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"13703010320","LABEL_NAME":"VANISHPOINT 23GX1-1/2 3 ML SYR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"13703010330","LABEL_NAME":"VANISHPOINT 22GX1\" 3 ML SYR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"13703010340","LABEL_NAME":"VANISHPOINT 3 ML 22GX1.5\" SYRG","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"13703010350","LABEL_NAME":"VANISHPOINT 3 ML 21GX1\" SYRING","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"13703010360","LABEL_NAME":"VANISHPOINT 21GX1.5\" 3 ML SYR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"13703010370","LABEL_NAME":"VANISHPOINT 20GX1\" 3 ML SYRING","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"13703010390","LABEL_NAME":"VANISHPOINT 25GX1\" 3 ML SYRING","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"13703010540","LABEL_NAME":"VANISHPOINT 22GX1-1/2\" 5 ML SY","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"13703010550","LABEL_NAME":"VANISHPOINT 21GX1\" 5 ML SYRING","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"13703010560","LABEL_NAME":"VANISHPOINT 5 ML 21GX1-1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"13703011060","LABEL_NAME":"VANISHPOINT 10 ML 21GX1-1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"13703013010","LABEL_NAME":"VANISHPOINT SYR 3 ML 25G 38MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"13703013021","LABEL_NAME":"VANISHPOINT 3 ML 27G 1-1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"13703015220","LABEL_NAME":"VANISHPOINT 0.5 ML 30GX1/2\" SY","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13703082010","LABEL_NAME":"EASYPOINT NEEDLE 25G X 1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13703082030","LABEL_NAME":"EASYPOINT NEEDLE 23G X 1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13703082090","LABEL_NAME":"EASYPOINT NEEDLE 25G X 5/8\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13703085010","LABEL_NAME":"EASYPOINT NEEDLE 25G 1.5\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13703085021","LABEL_NAME":"EASYPOINT NEEDLE 22G X 1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13703085031","LABEL_NAME":"EASYPOINT NEEDLE 22G X 1-1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13703085041","LABEL_NAME":"EASYPOINT NEEDLE 21G X 1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13703085051","LABEL_NAME":"EASYPOINT NEEDLE 21G X 1-1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13703085061","LABEL_NAME":"EASYPOINT NEEDLE 20G X 1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13703085071","LABEL_NAME":"EASYPOINT NEEDLE 20G X 1-1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13703085081","LABEL_NAME":"EASYPOINT NEEDLE 18G X 1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13703085091","LABEL_NAME":"EASYPOINT NEEDLE 18G X 1-1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13703085290","LABEL_NAME":"EASYPOINT NEEDLE 25G 16MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13811000710","LABEL_NAME":"TRINATAL RX 1 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13811001030","LABEL_NAME":"COMPLETE NATAL DHA","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13811002710","LABEL_NAME":"ELITE-OB CAPLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13811053530","LABEL_NAME":"FOLIVANE-OB CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13811053630","LABEL_NAME":"TARON-C DHA CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13811054330","LABEL_NAME":"TARON-PREX PRENATAL DHA CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13811058030","LABEL_NAME":"ZATEAN-PN DHA CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13811058230","LABEL_NAME":"ZATEAN-PN PLUS SOFTGEL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13811070410","LABEL_NAME":"HYDROMORPHONE HCL ER 32 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13811070610","LABEL_NAME":"METHYLPHENIDATE ER 18 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13845120202","LABEL_NAME":"CYCLOSERINE 250 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13874002003","LABEL_NAME":"ALLERGY (LORATADINE) 10 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"13874002037","LABEL_NAME":"8HR ARTHRITIS PAIN ER 650 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"13925011601","LABEL_NAME":"SE-NATAL 19 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13925011701","LABEL_NAME":"SE-NATAL 19 CHEWABLE TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13925016604","LABEL_NAME":"PREDNISOLONE 5 MG/5 ML SOLN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"13925052201","LABEL_NAME":"PENTAMIDINE 300 MG INHAL POWDR","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"14428000003","LABEL_NAME":"BACITRAYCIN PLUS 500 UNIT/GM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"15054001001","LABEL_NAME":"SOHONOS 1 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"15054001501","LABEL_NAME":"SOHONOS 1.5 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"15054002501","LABEL_NAME":"SOHONOS 2.5 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"15054005001","LABEL_NAME":"SOHONOS 5 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"15054008001","LABEL_NAME":"IQIRVO 80 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"15054010001","LABEL_NAME":"SOHONOS 10 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"15054050001","LABEL_NAME":"DYSPORT 500 UNIT VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"15054104005","LABEL_NAME":"INCRELEX 40 MG/4 ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"15054106004","LABEL_NAME":"SOMATULINE DEPOT 60 MG/0.2 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"15054109004","LABEL_NAME":"SOMATULINE DEPOT 90 MG/0.3 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"15054112004","LABEL_NAME":"SOMATULINE DEPOT 120 MG/0.5 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"15054330101","LABEL_NAME":"BYLVAY 200 MCG PELLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"15054330201","LABEL_NAME":"BYLVAY 400 MCG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"15054330301","LABEL_NAME":"BYLVAY 600 MCG PELLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"15054330401","LABEL_NAME":"BYLVAY 1,200 MCG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16042001201","LABEL_NAME":"FORA 30G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"16042001203","LABEL_NAME":"FORA LANCING DEVICE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"16103037608","LABEL_NAME":"PAIN RELIEF 500 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"16169001012","LABEL_NAME":"KIMONO THIN LUBRICATED CONDOMS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"16169003012","LABEL_NAME":"KIMONO MAXX CONDOM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"16169005003","LABEL_NAME":"KIMONO MICROTHIN CONDOM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"16169006003","LABEL_NAME":"KIMONO MICROTHIN AQUA LUBE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"16169007003","LABEL_NAME":"KIMONO TEXTURED CONDOM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"16169008003","LABEL_NAME":"KIMONO MICROTHIN LARGE CONDOM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"16252053901","LABEL_NAME":"ISRADIPINE 2.5 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16252054001","LABEL_NAME":"ISRADIPINE 5 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16477042206","LABEL_NAME":"SELENIUM SULFIDE 2.25% SHAMPOO","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16477073801","LABEL_NAME":"HYOSCYAMINE ER 0.375 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16500051020","LABEL_NAME":"CUTTER 10% SPRAY","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"16500054010","LABEL_NAME":"CUTTER SKINSATIONS 7% SPRAY","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"16526001001","LABEL_NAME":"ST. JOSEPH ASPIRIN EC 81 MG TB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"16571013412","LABEL_NAME":"CETIRIZINE HCL 1 MG/ML SYRUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16571015801","LABEL_NAME":"CARBIDOPA-LEVO 25-100 MG ODT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16571017303","LABEL_NAME":"EPLERENONE 25 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16571017403","LABEL_NAME":"EPLERENONE 50 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16571020310","LABEL_NAME":"DICLOFENAC SOD EC 25 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16571021010","LABEL_NAME":"FLUCONAZOLE 50 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16571022301","LABEL_NAME":"TIMOLOL MALEATE 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16571022501","LABEL_NAME":"TIMOLOL MALEATE 20 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16571024603","LABEL_NAME":"MESALAMINE 1,000 MG SUPP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16571060096","LABEL_NAME":"CROMOLYN 100 MG/5 ML ORAL CONC","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16571068607","LABEL_NAME":"CLOTRIMAZOLE 10 MG LOZENGE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16571075453","LABEL_NAME":"NEOMYC-BACIT-POLYMIX EYE OINT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16571075809","LABEL_NAME":"NATEGLINIDE 60 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16571076209","LABEL_NAME":"LEVOCARNITINE 330 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16571076924","LABEL_NAME":"ESCITALOPRAM OXALATE 5 MG/5 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16571077301","LABEL_NAME":"GLIMEPIRIDE 1 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16571077401","LABEL_NAME":"GLIMEPIRIDE 2 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16571077501","LABEL_NAME":"GLIMEPIRIDE 4 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16571078101","LABEL_NAME":"CARISOPRODOL 350 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16571078406","LABEL_NAME":"GEMFIBROZIL 600 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16571078501","LABEL_NAME":"LAMOTRIGINE 5 MG DISPER TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16571078601","LABEL_NAME":"LAMOTRIGINE 25 MG DISPER TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16571080316","LABEL_NAME":"ZOLMITRIPTAN 2.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16571080413","LABEL_NAME":"ZOLMITRIPTAN 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16571080606","LABEL_NAME":"SIROLIMUS 1 MG/ML SOLUTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16571081001","LABEL_NAME":"TRIENTINE HCL 250 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16571081205","LABEL_NAME":"TRIENTINE HCL 500 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16571081450","LABEL_NAME":"DENTA 5000 PLUS CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16571081560","LABEL_NAME":"DENTAGEL 1.1% GEL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16571081641","LABEL_NAME":"TEMOZOLOMIDE 5 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16571081741","LABEL_NAME":"TEMOZOLOMIDE 20 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16571081841","LABEL_NAME":"TEMOZOLOMIDE 100 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16571081941","LABEL_NAME":"TEMOZOLOMIDE 140 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16571082041","LABEL_NAME":"TEMOZOLOMIDE 180 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16571082151","LABEL_NAME":"TEMOZOLOMIDE 250 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16571082310","LABEL_NAME":"DENTA 5000 PLUS SENSITIV PASTE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16571083201","LABEL_NAME":"PROBENECID-COLCHICINE TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16571083501","LABEL_NAME":"AZATHIOPRINE 50 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16571085303","LABEL_NAME":"MEMANTINE HCL ER 14 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16571085403","LABEL_NAME":"MEMANTINE HCL ER 21 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16571085503","LABEL_NAME":"MEMANTINE HCL ER 28 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714001001","LABEL_NAME":"ISOSORBIDE DINITRATE 30 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714002901","LABEL_NAME":"ETONOGESTREL-EE VAGINAL RING","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714006701","LABEL_NAME":"CARBIDOPA 25 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714015701","LABEL_NAME":"PROGESTERONE 100 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714015801","LABEL_NAME":"PROGESTERONE 200 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714017101","LABEL_NAME":"TIZANIDINE HCL 2 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714018701","LABEL_NAME":"SIROLIMUS 0.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714018901","LABEL_NAME":"SIROLIMUS 2 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714020010","LABEL_NAME":"ONDANSETRON ODT 4 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714020110","LABEL_NAME":"ONDANSETRON ODT 8 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714026801","LABEL_NAME":"TRIAMCINOLONE 0.5% OINTMENT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714034001","LABEL_NAME":"LEVONEST-28 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714034601","LABEL_NAME":"DASETTA 7/7/7-28 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714034701","LABEL_NAME":"PHILITH 0.4-0.035 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714034801","LABEL_NAME":"DASETTA 1-35-28 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714035901","LABEL_NAME":"FALMINA-28 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714036001","LABEL_NAME":"MONO-LINYAH 28 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714036301","LABEL_NAME":"TRI-LINYAH TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714036501","LABEL_NAME":"ELINEST-28 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714036601","LABEL_NAME":"SETLAKIN 0.15 MG-0.03 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714037001","LABEL_NAME":"WERA 0.5/0.035 MG 28 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714038901","LABEL_NAME":"CEFADROXIL 250 MG/5 ML SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714039001","LABEL_NAME":"CEFADROXIL 500 MG/5 ML SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714039603","LABEL_NAME":"CEFPROZIL 125 MG/5 ML SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714039701","LABEL_NAME":"CEFPROZIL 250 MG/5 ML SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714040101","LABEL_NAME":"CEFUROXIME AXETIL 500 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714040201","LABEL_NAME":"CEFPODOXIME 50 MG/5 ML SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714040301","LABEL_NAME":"CEFPODOXIME 100 MG/5 ML SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714040401","LABEL_NAME":"PIMTREA 28 DAY TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714040501","LABEL_NAME":"LARIN FE 1.5-30 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714040601","LABEL_NAME":"LARIN FE 1-20 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714040701","LABEL_NAME":"LARIN 1.5 MG-30 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714040801","LABEL_NAME":"LARIN 21 1-20 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714041601","LABEL_NAME":"LARIN 24 FE 1 MG-20 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714044001","LABEL_NAME":"DEBLITANE 0.35 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714044101","LABEL_NAME":"SHAROBEL 0.35 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714046401","LABEL_NAME":"JULEBER 28 DAY TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714052301","LABEL_NAME":"DILTIAZEM 24H ER(XR) 120 MG CP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714052401","LABEL_NAME":"DILTIAZEM 24H ER(XR) 180 MG CP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714052501","LABEL_NAME":"DILTIAZEM 24H ER(XR) 240 MG CP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714052901","LABEL_NAME":"BISOPROLOL FUMARATE 5 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714053001","LABEL_NAME":"BISOPROLOL FUMARATE 10 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714057001","LABEL_NAME":"PRAVASTATIN SODIUM 80 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714063101","LABEL_NAME":"ALENDRONATE SODIUM 10 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714068101","LABEL_NAME":"SIMVASTATIN 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714068201","LABEL_NAME":"SIMVASTATIN 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714068301","LABEL_NAME":"SIMVASTATIN 20 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714068401","LABEL_NAME":"SIMVASTATIN 40 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714068501","LABEL_NAME":"SIMVASTATIN 80 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714069210","LABEL_NAME":"FLUCONAZOLE 150 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714069501","LABEL_NAME":"FLUCONAZOLE 10 MG/ML SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714069601","LABEL_NAME":"FLUCONAZOLE 40 MG/ML SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714076301","LABEL_NAME":"CALCIPOTRIENE 0.005% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714077501","LABEL_NAME":"FELBAMATE 600 MG/5 ML SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714077902","LABEL_NAME":"EZETIMIBE-SIMVASTATIN 10-20 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714078002","LABEL_NAME":"EZETIMIBE-SIMVASTATIN 10-40 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714078101","LABEL_NAME":"EZETIMIBE-SIMVASTATIN 10-80 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714079501","LABEL_NAME":"TERBINAFINE HCL 250 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714080901","LABEL_NAME":"NEW DAY 1.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"16714086601","LABEL_NAME":"PALIPERIDONE ER 1.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714089401","LABEL_NAME":"GLIPIZIDE ER 2.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714089501","LABEL_NAME":"GLIPIZIDE ER 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714089601","LABEL_NAME":"GLIPIZIDE ER 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714089701","LABEL_NAME":"PERMETHRIN 5% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16714096801","LABEL_NAME":"TESTOSTERONE 1.62%(1.25 G) PKT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16729033101","LABEL_NAME":"ACETAZOLAMIDE ER 500 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16729036615","LABEL_NAME":"OLMESARTAN-HCTZ 20-12.5 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16729036715","LABEL_NAME":"OLMESARTAN-HCTZ 40-12.5 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16729036815","LABEL_NAME":"OLMESARTAN-HCTZ 40-25 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16729041604","LABEL_NAME":"DIMETHYL FUMARATE DR 120 MG CP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16729041712","LABEL_NAME":"DIMETHYL FUMARATE DR 240 MG CP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16729053303","LABEL_NAME":"DODEX 10,000 MCG/10 ML VIAL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16729053310","LABEL_NAME":"DODEX 30,000 MCG/30 ML VIAL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16784069402","LABEL_NAME":"INSULIN SYRING 0.5 ML 27G 13MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16784069403","LABEL_NAME":"INSULIN SYRING 0.5 ML 27G 1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16784069452","LABEL_NAME":"INSULIN SYRINGE 1 ML 27G 13MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16784069453","LABEL_NAME":"INSULIN SYRINGE 1 ML 27GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16784069462","LABEL_NAME":"INSULIN SYRINGE 1 ML 28G 13MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16784069472","LABEL_NAME":"INSULIN SYRINGE 1 ML 29G 1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16784069482","LABEL_NAME":"INSULIN SYRINGE 1 ML 30G 1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16784069492","LABEL_NAME":"INSULIN SYRINGE 1 ML 31G 5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16784069511","LABEL_NAME":"INSULIN SYRING 0.5 ML 28G 1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16784069513","LABEL_NAME":"INSULIN SYRIN 0.5 ML 28G 1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16784069521","LABEL_NAME":"INSULIN SYRING 0.5 ML 29G 1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16784069531","LABEL_NAME":"INSULIN SYRIN 0.5 ML 30G 5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16784069541","LABEL_NAME":"INSULIN SYRIN 0.5 ML 31G 5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16784069551","LABEL_NAME":"INSULIN SYRINGE 1 ML 27G 1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16784069561","LABEL_NAME":"INSULIN SYRINGE 1 ML 28G 1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16784069613","LABEL_NAME":"HYPODERMIC NEEDLE 18G 1-1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16784069753","LABEL_NAME":"HYPODERMIC NEEDLE 27G 1-1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16784069763","LABEL_NAME":"HYPODERMIC NEEDLE 27G 1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16784069902","LABEL_NAME":"SYRINGE LUER LOCK 10 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16784070013","LABEL_NAME":"SYRINGE WITH NEEDLE 3ML 23G 1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16784070103","LABEL_NAME":"SYRINGE LUER LOCK 10 ML 20G 1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16784071122","LABEL_NAME":"SENSILANCE 21G SAFETY LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"16784071142","LABEL_NAME":"SENSILANCE 26G SAFETY LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"16784071152","LABEL_NAME":"SENSILANCE 28G SAFETY LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"16784071342","LABEL_NAME":"ADVANTAGE SAFETY 28G LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"16784089012","LABEL_NAME":"SECURESAFE SYR 0.5 ML 29G 1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"16784089042","LABEL_NAME":"SECURESAFE SYRNG 1 ML 29G 1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"17772013130","LABEL_NAME":"QELBREE ER 100 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"17772013230","LABEL_NAME":"QELBREE ER 150 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"17772013330","LABEL_NAME":"QELBREE ER 200 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"17856031202","LABEL_NAME":"GAVILAX 8.5 GRAM POWDER PACKET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"19515090441","LABEL_NAME":"FLULAVAL 2025-2026 SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"21130030602","LABEL_NAME":"SW CLEARLAX POWDER","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"21130030603","LABEL_NAME":"SW CLEARLAX POWDER","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"21130034405","LABEL_NAME":"SW NICOTINE 2 MG LOZENGE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"21130035278","LABEL_NAME":"SW NICOTINE 2 MG CHEWING GUM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"21130045839","LABEL_NAME":"SW ALLERGY RELIEF 10 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"21130053278","LABEL_NAME":"SW NICOTINE 4 MG CHEWING GUM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"21130087305","LABEL_NAME":"SW NICOTINE 4 MG LOZENGE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"21292000495","LABEL_NAME":"TRUEPLUS SYR 0.5ML 28GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"21292000496","LABEL_NAME":"TRUEPLUS SYR 1ML 28GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"21292000497","LABEL_NAME":"TRUEPLUS SYR 0.3ML 29GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"21292000498","LABEL_NAME":"TRUEPLUS SYR 0.5ML 29GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"21292000499","LABEL_NAME":"TRUEPLUS SYR 1ML 29GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"21292000500","LABEL_NAME":"TRUEPLUS SYR 0.3ML 30GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"21292000501","LABEL_NAME":"TRUEPLUS SYR 0.5ML 30GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"21292000502","LABEL_NAME":"TRUEPLUS SYR 1ML 30GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"21292000503","LABEL_NAME":"TRUEPLUS SYR 0.3ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"21292000504","LABEL_NAME":"TRUEPLUS SYR 0.5ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"21292000505","LABEL_NAME":"TRUEPLUS SYR 1ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"21292001052","LABEL_NAME":"TRUEPLUS SAFETY 28G LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"21922000404","LABEL_NAME":"DESONIDE 0.05% OINTMENT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"21922002206","LABEL_NAME":"CLIND PH-BENZOYL PEROX 1.2-5%","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"21922003104","LABEL_NAME":"NYSTATIN-TRIAMCINOLONE OINTM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"21922004112","LABEL_NAME":"FLUOROURACIL 5% TOPICAL SOLN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"21922004547","LABEL_NAME":"MESALAMINE 4 GM/60 ML ENEMA","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"21922005250","LABEL_NAME":"ADAPALENE-BNZYL PEROX 0.1-2.5%","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"21922005351","LABEL_NAME":"CICLOPIROX 8% SOLUTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"21922007201","LABEL_NAME":"MOMETASONE FUROATE 0.1% SOLN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"21922009506","LABEL_NAME":"ANTIFUNGAL 2% TOPICAL CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"22600064203","LABEL_NAME":"TROJAN MAGNUM CONDOM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"22600092050","LABEL_NAME":"TROJAN ENZ CONDOM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"22600092620","LABEL_NAME":"TROJAN ULTRA THIN CONDOM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"22600092720","LABEL_NAME":"TROJAN ULTRA THIN-SPERMICIDAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"22600093050","LABEL_NAME":"TROJAN ENZ CONDOM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"22600093150","LABEL_NAME":"TROJAN ENZ SPERMICIDE CONDOM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"22600094050","LABEL_NAME":"TROJAN ULTRA RIBBED CONDOM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"22600099965","LABEL_NAME":"TROJAN BARESKIN PACK CONDOM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"22840010290","LABEL_NAME":"PALFORZIA 6 MG (LEVEL 2)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"22840010345","LABEL_NAME":"PALFORZIA 12 MG (LEVEL 3)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"22840010415","LABEL_NAME":"PALFORZIA 20 MG (LEVEL 4)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"22840010530","LABEL_NAME":"PALFORZIA 40 MG (LEVEL 5)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"22840010660","LABEL_NAME":"PALFORZIA 80 MG (LEVEL 6)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"22840010730","LABEL_NAME":"PALFORZIA 120 MG (LEVEL 7)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"22840010860","LABEL_NAME":"PALFORZIA 160 MG (LEVEL 8)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"22840010930","LABEL_NAME":"PALFORZIA 200 MG (LEVEL 9)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"22840011060","LABEL_NAME":"PALFORZIA 240 MG (LEVEL 10)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"22840011115","LABEL_NAME":"PALFORZIA 300 MG (LEVEL 11)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"22840011130","LABEL_NAME":"PALFORZIA 300 MG (MAINTENANCE)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"22840011313","LABEL_NAME":"PALFORZIA INITIAL (4-17 YRS)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"22840011407","LABEL_NAME":"PALFORZIA INITIAL (1-3 YRS)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"22840012615","LABEL_NAME":"PALFORZIA 1 MG (LEVEL 0)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"22840012745","LABEL_NAME":"PALFORZIA 3 MG (LEVEL 1)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"23155001001","LABEL_NAME":"INDOMETHACIN 25 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"23155001101","LABEL_NAME":"INDOMETHACIN 50 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"23155004303","LABEL_NAME":"LEFLUNOMIDE 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"23155004403","LABEL_NAME":"LEFLUNOMIDE 20 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"23155006001","LABEL_NAME":"FOSINOPRIL-HCTZ 10-12.5 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"23155006101","LABEL_NAME":"FOSINOPRIL-HCTZ 20-12.5 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"23155019501","LABEL_NAME":"NIFEDIPINE 20 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"23155022801","LABEL_NAME":"ACYCLOVIR 800 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"23155023301","LABEL_NAME":"GLYBURID-METFORMIN 1.25-250 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"23155023401","LABEL_NAME":"GLYBURIDE-METFORMIN 2.5-500 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"23155023501","LABEL_NAME":"GLYBURIDE-METFORMIN 5-500 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"23155031751","LABEL_NAME":"RISPERIDONE 1 MG/ML SOLUTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"23155048901","LABEL_NAME":"DESMOPRESSIN ACETATE 0.1 MG TB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"23155051200","LABEL_NAME":"NIMODIPINE 30 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"23155053201","LABEL_NAME":"ETHOSUXIMIDE 250 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"23155053825","LABEL_NAME":"DOXERCALCIFEROL 0.5 MCG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"23155053925","LABEL_NAME":"DOXERCALCIFEROL 1 MCG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"23155054025","LABEL_NAME":"DOXERCALCIFEROL 2.5 MCG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"23155057801","LABEL_NAME":"DESIPRAMINE 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"23155057901","LABEL_NAME":"DESIPRAMINE 25 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"23155058001","LABEL_NAME":"DESIPRAMINE 50 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"23155058101","LABEL_NAME":"DESIPRAMINE 75 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"23155058201","LABEL_NAME":"DESIPRAMINE 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"23155058325","LABEL_NAME":"DESIPRAMINE 150 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"23155060351","LABEL_NAME":"CLINDAMYCIN (PEDI) 75 MG/5 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"23155062102","LABEL_NAME":"CALCIUM ACETATE 667 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"23155073501","LABEL_NAME":"TERAZOSIN 1 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"23155074901","LABEL_NAME":"BENAZEPRIL HCL 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"23155075001","LABEL_NAME":"BENAZEPRIL HCL 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"23155075101","LABEL_NAME":"BENAZEPRIL HCL 20 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"23155075201","LABEL_NAME":"BENAZEPRIL HCL 40 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"23155080901","LABEL_NAME":"VITAMIN D2 1.25MG(50,000 UNIT)","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"23155085825","LABEL_NAME":"VANCOMYCIN HCL 125 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"23155085925","LABEL_NAME":"VANCOMYCIN HCL 250 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"23155087101","LABEL_NAME":"TORSEMIDE 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"23155087201","LABEL_NAME":"TORSEMIDE 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"23155087401","LABEL_NAME":"TORSEMIDE 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"23155089406","LABEL_NAME":"TOPIRAMATE 15 MG SPRINKLE CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"23155089506","LABEL_NAME":"TOPIRAMATE 25 MG SPRINKLE CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"23155092001","LABEL_NAME":"AMLODIPINE-BENAZEPRIL 2.5-10","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"23155092201","LABEL_NAME":"AMLODIPINE-BENAZEPRIL 5-20 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"23155092501","LABEL_NAME":"AMLODIPINE-BENAZEPRIL 10-40 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"23155092651","LABEL_NAME":"HYDROCORTISONE 100 MG/60 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"23155093863","LABEL_NAME":"TETRABENAZINE 12.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"23155093963","LABEL_NAME":"TETRABENAZINE 25 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"23594012501","LABEL_NAME":"CEFACLOR 125 MG/5 ML SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"23594037501","LABEL_NAME":"CEFACLOR 375 MG/5 ML SUSPEN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"23594090101","LABEL_NAME":"FLEXICHAMBER","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"24201046301","LABEL_NAME":"DIHYDROERGOTAMINE 4 MG/ML SPRY","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"24208029005","LABEL_NAME":"TOBRAMYCIN 0.3% EYE DROP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"24208031510","LABEL_NAME":"POLYMYXIN B-TMP EYE DROPS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"24208031705","LABEL_NAME":"SULF-PRED 10-0.23% EYE DROPS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"24208034205","LABEL_NAME":"DESMOPRESSIN 0.01% SOLUTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"24208034425","LABEL_NAME":"FLUNISOLIDE 0.025% SPRAY","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"24208041005","LABEL_NAME":"OFLOXACIN 0.3% EAR DROPS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"24208041105","LABEL_NAME":"BRIMONIDINE 0.2% EYE DROP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"24208045705","LABEL_NAME":"DICLOFENAC 0.1% EYE DROPS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"24208046325","LABEL_NAME":"LATANOPROST 0.005% EYE DROPS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"24208048510","LABEL_NAME":"DORZOLAMIDE HCL 2% EYE DROPS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"24208048610","LABEL_NAME":"DORZOLAMIDE-TIMOLOL EYE DROPS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"24208050505","LABEL_NAME":"LEVOBUNOLOL 0.5% EYE DROPS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"24208053535","LABEL_NAME":"ZIRGAN 0.15% OPHTHALMIC GEL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"24208055555","LABEL_NAME":"BACITRACIN-POLYMYXIN EYE OINT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"24208058060","LABEL_NAME":"GENTAMICIN 0.3% EYE DROP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"24208058564","LABEL_NAME":"TROPICAMIDE 1% EYE DROP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"24208059064","LABEL_NAME":"TROPICAMIDE 0.5% EYE DROP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"24208063110","LABEL_NAME":"NEOMYCIN-POLYMYXIN-HC EAR SOLN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"24208063562","LABEL_NAME":"NEOMYCIN-POLYMYXIN-HC EAR SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"24208067004","LABEL_NAME":"SULFACETAMIDE 10% EYE DROPS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"24208071510","LABEL_NAME":"PREDNISOLONE SOD 1% EYE DROP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"24208072002","LABEL_NAME":"DEXAMETHASONE 0.1% EYE DROP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"24208073501","LABEL_NAME":"CYCLOPENTOLATE 1% EYE DROPS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"24208073506","LABEL_NAME":"CYCLOPENTOLATE 1% EYE DROP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"24208078555","LABEL_NAME":"NEO-BACIT-POLY-HC EYE OINTMENT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"24208079062","LABEL_NAME":"NEOMYC-POLYM-GRAMICID EYE DROP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"24208079535","LABEL_NAME":"NEOMYC-POLYM-DEXAMET EYE OINTM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"24208083060","LABEL_NAME":"NEOMYC-POLYM-DEXAMETH EYE DROP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"24208091105","LABEL_NAME":"XIIDRA 5% EYE DROPS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"24338001801","LABEL_NAME":"MYHIBBIN 200 MG/ML SUSPENSION","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"24338010003","LABEL_NAME":"E.E.S. 400 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"24338010603","LABEL_NAME":"ERYTHROCIN 250 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"24338011003","LABEL_NAME":"ERYTHROMYCIN ES 400 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"24338012203","LABEL_NAME":"ERY-TAB DR 250 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"24338012403","LABEL_NAME":"ERY-TAB DR 333 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"24338015020","LABEL_NAME":"TRIPTODUR 22.5 MG KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"24338015401","LABEL_NAME":"DANZITEN 71 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"24338015501","LABEL_NAME":"DANZITEN 95 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"24338085103","LABEL_NAME":"ZENZEDI 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"24338085303","LABEL_NAME":"ZENZEDI 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"24385014626","LABEL_NAME":"CHILD'S PAIN RELIEVER SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"24385032558","LABEL_NAME":"SALINE 0.65% NOSE SPRAY","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"24385035934","LABEL_NAME":"TUSSIN DM SYRUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"24385037926","LABEL_NAME":"DIPHEDRYL 12.5 MG/5 ML ELIXIR","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"24385047152","LABEL_NAME":"GNP LORATADINE 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"24385048447","LABEL_NAME":"GNP PAIN RELIEF 500 MG CAPLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"24385048471","LABEL_NAME":"GNP PAIN RELIEF 500 MG CAPLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"24385051926","LABEL_NAME":"COLD-COUGH ELIXIR","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"24385053126","LABEL_NAME":"ALLERGY RELIEF 5 MG/5 ML SOLN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"24385060265","LABEL_NAME":"GNP MUCUS RELIEF 400 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"24385099865","LABEL_NAME":"ALL DAY ALLERGY 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"24470090004","LABEL_NAME":"BP WASH 5% LIQUID","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"24470090108","LABEL_NAME":"BP WASH 10% LIQUID","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"24470091710","LABEL_NAME":"ERGOTAMINE-CAFFEINE 1-100MG TB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"24470092508","LABEL_NAME":"SOD SULFACET-SULFUR 10-5% CLSR","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"24658026695","LABEL_NAME":"CHOLESTYRAMINE PACKET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"24658027095","LABEL_NAME":"CHOLESTYRAMINE LIGHT PACKET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"24658027197","LABEL_NAME":"CHOLESTYRAMINE LIGHT POWDER","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"24658080130","LABEL_NAME":"RIFAMPIN 150 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"24689012201","LABEL_NAME":"GUAIFENESIN 400 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"24979003007","LABEL_NAME":"DILTIAZEM 24H ER(CD) 360 MG CP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"24979023201","LABEL_NAME":"POTASSIUM CL ER 20 MEQ TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"24979072204","LABEL_NAME":"GALANTAMINE HBR 4 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"24979072304","LABEL_NAME":"GALANTAMINE HBR 8 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"24979072404","LABEL_NAME":"GALANTAMINE HBR 12 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"25021040304","LABEL_NAME":"HEPARIN 40,000 UNIT/4 ML VIAL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"25021040401","LABEL_NAME":"HEPARIN SOD 20,000 UNIT/ML VL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"25021046001","LABEL_NAME":"DESMOPRESSIN AC 4 MCG/ML VIAL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"25021046110","LABEL_NAME":"DESMOPRESSIN 40 MCG/10 ML VIAL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"25021060203","LABEL_NAME":"CAFFEINE CIT 60 MG/3 ML ORAL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"25021083101","LABEL_NAME":"HALOPERIDOL DEC 50 MG/ML VIAL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"25682001001","LABEL_NAME":"STRENSIQ 18 MG/0.45 ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"25682001301","LABEL_NAME":"STRENSIQ 28 MG/0.7 ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"25682001601","LABEL_NAME":"STRENSIQ 40 MG/ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"25682001901","LABEL_NAME":"STRENSIQ 80 MG/0.8 ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"25682004392","LABEL_NAME":"VOYDEYA 100 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"25682004692","LABEL_NAME":"VOYDEYA 150 MG DOSE TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"27241008303","LABEL_NAME":"AMLODIPINE-OLMESARTAN 5-20 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"27241008403","LABEL_NAME":"AMLODIPINE-OLMESARTAN 5-40 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"27241008603","LABEL_NAME":"AMLODIPINE-OLMESARTAN 10-40 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"27241012602","LABEL_NAME":"RANOLAZINE ER 1,000 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"27241014401","LABEL_NAME":"SILODOSIN 4 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"27241014501","LABEL_NAME":"SILODOSIN 8 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"27241023701","LABEL_NAME":"OXCARBAZEPINE ER 150 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"27241023801","LABEL_NAME":"OXCARBAZEPINE ER 300 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"27241023901","LABEL_NAME":"OXCARBAZEPINE ER 600 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"27505000605","LABEL_NAME":"ONAPGO 98 MG/20 ML CARTRIDGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"27808005801","LABEL_NAME":"METHYLPHENIDATE 5 MG/5 ML SOLN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"27808005901","LABEL_NAME":"METHYLPHENIDATE 10 MG/5 ML SOL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"27808008601","LABEL_NAME":"HYDROCODONE-CHLORPHEN ER SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"27808024901","LABEL_NAME":"DEFLAZACORT 22.75 MG/ML SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"29300011605","LABEL_NAME":"TOPIRAMATE 50 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"29300011805","LABEL_NAME":"TOPIRAMATE 200 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"29300013801","LABEL_NAME":"DIVALPROEX SOD DR 125 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"29300015501","LABEL_NAME":"ALFUZOSIN HCL ER 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"29300021213","LABEL_NAME":"IRBESARTAN 75 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"29300021313","LABEL_NAME":"IRBESARTAN 150 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"29300021413","LABEL_NAME":"IRBESARTAN 300 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"29300025011","LABEL_NAME":"DONEPEZIL HCL ODT 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"29300025111","LABEL_NAME":"DONEPEZIL HCL ODT 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"29300026891","LABEL_NAME":"RIZATRIPTAN 5 MG ODT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"29300026991","LABEL_NAME":"RIZATRIPTAN 10 MG ODT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"29300035905","LABEL_NAME":"AMIODARONE HCL 200 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"29300042801","LABEL_NAME":"ZONISAMIDE 25 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"29300042901","LABEL_NAME":"ZONISAMIDE 50 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"29300043001","LABEL_NAME":"ZONISAMIDE 100 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"30142002925","LABEL_NAME":"KRO NICOTINE 2 MG CHEWING GUM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"30142016634","LABEL_NAME":"KRO CHLD IBUPROFEN 100 MG/5 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"30142030602","LABEL_NAME":"KRO GENTLELAX 17 GRAM POWDER","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"30142030603","LABEL_NAME":"GENTLELAX POWDER","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"30142034405","LABEL_NAME":"KRO NICOTINE 2 MG LOZENGE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"30142046768","LABEL_NAME":"KRO ASPIRIN 81 MG CHEWABLE TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"30142082529","LABEL_NAME":"KRO MICONAZOLE 7 CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"30142085478","LABEL_NAME":"KRO NICOTINE 4 MG CHEWING GUM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"30142087305","LABEL_NAME":"KRO NICOTINE 4 MG LOZENGE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"30142098726","LABEL_NAME":"KRO CHILDREN COLD-COUGH ELIXIR","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"30698041912","LABEL_NAME":"EQUETRO 100 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"30698042112","LABEL_NAME":"EQUETRO 200 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"30698042312","LABEL_NAME":"EQUETRO 300 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"30768000601","LABEL_NAME":"B-COMPLEX TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"31604002727","LABEL_NAME":"SUPER B COMPLEX TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"31722000760","LABEL_NAME":"ZAFIRLUKAST 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"31722000860","LABEL_NAME":"ZAFIRLUKAST 20 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"31722000950","LABEL_NAME":"VIGABATRIN 500 MG POWDER PACKT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"31722001130","LABEL_NAME":"DEFERASIROX 90 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"31722001230","LABEL_NAME":"DEFERASIROX 180 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"31722001330","LABEL_NAME":"DEFERASIROX 360 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"31722001647","LABEL_NAME":"GLYCOPYRROLATE 1 MG/5 ML SOLN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"31722002501","LABEL_NAME":"OXCARBAZEPINE 600 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"31722002932","LABEL_NAME":"DEFERASIROX 90 MG GRANULE PKT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"31722003031","LABEL_NAME":"DEFERASIROX 180 MG GRANULE PKT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"31722003131","LABEL_NAME":"DEFERASIROX 360 MG GRANULE PKT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"31722004031","LABEL_NAME":"PROMETHAZINE 12.5 MG SUPPOS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"31722004131","LABEL_NAME":"PROMETHAZINE 25 MG SUPPOSITORY","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"31722004701","LABEL_NAME":"SAPROPTERIN 100 MG POWDER PKT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"31722004801","LABEL_NAME":"SAPROPTERIN 500 MG POWDER PKT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"31722005360","LABEL_NAME":"IVABRADINE HCL 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"31722005460","LABEL_NAME":"IVABRADINE HCL 7.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"31722008930","LABEL_NAME":"DARUNAVIR 800 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"31722013130","LABEL_NAME":"DUTASTERIDE 0.5 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"31722030032","LABEL_NAME":"ELTROMBOPAG 12.5 MG SUSP PKT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"31722030132","LABEL_NAME":"ELTROMBOPAG 25 MG SUSP PACKET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"31722049618","LABEL_NAME":"RIVAROXABAN 2.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"31722050430","LABEL_NAME":"EFAVIRENZ 600 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"31722050660","LABEL_NAME":"LAMIVUDINE-ZIDOVUDINE TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"31722050960","LABEL_NAME":"ZIDOVUDINE 300 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"31722055612","LABEL_NAME":"LOPINAVIR-RITONAVR 200-50MG TB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"31722056224","LABEL_NAME":"ABACAVIR 20 MG/ML SOLUTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"31722056860","LABEL_NAME":"DARUNAVIR 600 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"31722057960","LABEL_NAME":"MARAVIROC 150 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"31722058060","LABEL_NAME":"MARAVIROC 300 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"31722060360","LABEL_NAME":"LOPINAVIR-RITONAVR 100-25MG TB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"31722062726","LABEL_NAME":"LACOSAMIDE 10 MG/ML SOLUTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"31722065931","LABEL_NAME":"LEVOCETIRIZINE 2.5 MG/5 ML SOL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"31722068060","LABEL_NAME":"DIMETHYL FUMARATE 30D START PK","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"31722083830","LABEL_NAME":"ABACAVIR-LAMIVUDINE 600-300 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"31722084130","LABEL_NAME":"ELTROMBOPAG 12.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"31722084230","LABEL_NAME":"ELTROMBOPAG 25 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"31722084330","LABEL_NAME":"ELTROMBOPAG 50 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"31722084430","LABEL_NAME":"ELTROMBOPAG 75 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"31722086803","LABEL_NAME":"TOLVAPTAN 15 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"31722086903","LABEL_NAME":"TOLVAPTAN 30 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"32671000901","LABEL_NAME":"PIP 30G LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"32671000903","LABEL_NAME":"PIP 28G LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"32671020233","LABEL_NAME":"LITE TOUCH 28G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"33332002503","LABEL_NAME":"AFLURIA 2025-2026 SYR (3YR UP)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"33332012510","LABEL_NAME":"AFLURIA 2025-2026 VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"33342000207","LABEL_NAME":"LAMIVUDINE 300 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"33342006707","LABEL_NAME":"OLANZAPINE 2.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"33342009009","LABEL_NAME":"RIVASTIGMINE 3 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"33342009109","LABEL_NAME":"RIVASTIGMINE 4.5 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"33342009209","LABEL_NAME":"RIVASTIGMINE 6 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"33342015001","LABEL_NAME":"IBANDRONATE SODIUM 150 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"33342017609","LABEL_NAME":"PIOGLITAZONE-METFORMIN 15-500","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"33342017709","LABEL_NAME":"PIOGLITAZONE-METFORMIN 15-850","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"33342024811","LABEL_NAME":"REPAGLINIDE 0.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"33342024911","LABEL_NAME":"REPAGLINIDE 1 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"33342025011","LABEL_NAME":"REPAGLINIDE 2 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"33342026907","LABEL_NAME":"TRAMADOL HCL ER 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"33342027007","LABEL_NAME":"TRAMADOL HCL ER 200 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"33342027107","LABEL_NAME":"TRAMADOL HCL ER 300 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"33342048215","LABEL_NAME":"NYSTATIN-TRIAMCINOLONE CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"35046000124","LABEL_NAME":"VITAMIN B-6 250 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"35046000131","LABEL_NAME":"VITAMIN B COMPLEX TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"35515094560","LABEL_NAME":"QC GLYCERIN 2 GM ADULT SUPPOS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"35515099198","LABEL_NAME":"QC ANTI-ITCH 1% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"35515099721","LABEL_NAME":"QC NON-ASPIRIN 500 MG CAPLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"35573010715","LABEL_NAME":"BETAMETHASONE DP AUG 0.05% OIN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"35573010813","LABEL_NAME":"SPS 15 GM/60 ML SUSPENSION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"35573043302","LABEL_NAME":"KETOCONAZOLE 200 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"35573043556","LABEL_NAME":"SODIUM FLUORIDE 1.1% GEL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"35573045602","LABEL_NAME":"BUTALBITAL-ACETAMINOPHN 50-325","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"35573045960","LABEL_NAME":"CARGLUMIC ACID 200 MG TAB SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"35573047302","LABEL_NAME":"PHENOXYBENZAMINE HCL 10 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"35873001874","LABEL_NAME":"NORM-JECT SYRINGE 10 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"35873001908","LABEL_NAME":"NORM-JECT TUBERKULIN SYR 1 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"36800004662","LABEL_NAME":"PAIN RELIEF 500 MG GELCAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"36800007009","LABEL_NAME":"MICONAZOLE 3 4% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"36800009208","LABEL_NAME":"CHILD LORATADINE 5 MG/5 ML SYR","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"36800018926","LABEL_NAME":"CHILD ALL DAY ALLERGY 1 MG/ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"36800021778","LABEL_NAME":"PAIN RELIEF ER 650 MG CAPLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"36800028826","LABEL_NAME":"CHILDREN'S MUCUS RELIEF LIQ","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"36800030601","LABEL_NAME":"CLEARLAX POWDER","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"36800030603","LABEL_NAME":"CLEARLAX POWDER","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"36800031026","LABEL_NAME":"TUSSIN CHEST CONGESTION LIQUID","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"36800035926","LABEL_NAME":"TUSSIN DM LIQUID","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"36800037926","LABEL_NAME":"CHILD'S ALLERGY 12.5 MG/5 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"36800040378","LABEL_NAME":"PAIN RELIEF 325 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"36800044164","LABEL_NAME":"SLEEP AID 25 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"36800044983","LABEL_NAME":"ALLERGY RELIEF 25 MG SOFTGEL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"36800046262","LABEL_NAME":"ALLERGY 25 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"36800048462","LABEL_NAME":"PAIN RELIEF 500 MG CAPLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"36800051526","LABEL_NAME":"TUSSIN MUCUS-CONG 200 MG/10 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"36800098726","LABEL_NAME":"CHILDREN'S COLD-COUGH ELIXIR","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"37864000021","LABEL_NAME":"DOCUSATE SODIUM 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"37864083703","LABEL_NAME":"PRENATAL VITAMIN TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"38396000425","LABEL_NAME":"VALUE PLUS LANCING DEVICE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"38396000506","LABEL_NAME":"KINRAY SYRING 0.3 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396000606","LABEL_NAME":"KINRAY SYRING 0.5 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396000706","LABEL_NAME":"KINRAY INS SYR 1 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396030100","LABEL_NAME":"E-ZJECT THIN LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"38396030114","LABEL_NAME":"RA E-ZJECT 26G LANCETS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"38396030120","LABEL_NAME":"MEIJER UNIVERSAL 1 26G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"38396030125","LABEL_NAME":"SMART SENSE THIN 26G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"38396030137","LABEL_NAME":"TOPCARE UNIVERSAL1 THIN LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"38396030175","LABEL_NAME":"CVS THIN 26G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"38396030191","LABEL_NAME":"THIN 26G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"38396030300","LABEL_NAME":"E-Z JECT LANCETS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"38396030318","LABEL_NAME":"KROGER SUPER THIN LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"38396030325","LABEL_NAME":"SMART SENSE STANDARD 21G","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"38396030418","LABEL_NAME":"KROGER LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"38396030500","LABEL_NAME":"E-Z JECT COLORED LANCETS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"38396030514","LABEL_NAME":"RA E-ZJECT 30G LANCETS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"38396030520","LABEL_NAME":"MEIJER LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"38396030522","LABEL_NAME":"REXALL UNIVERSAL 1 30G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"38396030525","LABEL_NAME":"SMART SENSE SUPER THIN 30G","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"38396030575","LABEL_NAME":"CVS ULTRA THIN 30G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"38396030800","LABEL_NAME":"E-ZJECT SUPER THIN 30G LANCETS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"38396030900","LABEL_NAME":"E-ZJECT COLOR 32G LANCETS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"38396031114","LABEL_NAME":"RA E-ZJECT 28G LANCETS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"38396031156","LABEL_NAME":"PREFERRED PLUS LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"38396031506","LABEL_NAME":"PREFERRED PLUS THIN LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"38396031600","LABEL_NAME":"E-ZJECT COLOR 33G LANCETS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"38396031614","LABEL_NAME":"RA E-ZJECT COLOR 33G LANCETS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"38396031620","LABEL_NAME":"UNIVERSAL 1 33G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"38396031625","LABEL_NAME":"SMART SENSE COLOR 33G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"38396031640","LABEL_NAME":"EQL MICRO THIN 33G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"38396031702","LABEL_NAME":"RELION ULTRA THIN PLUS 33G","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"38396031737","LABEL_NAME":"TOPCARE UNIVERSAL1 33G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"38396031739","LABEL_NAME":"SM MICRO THIN 33G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"38396031775","LABEL_NAME":"CVS MICRO THIN 33G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"38396032970","LABEL_NAME":"LONGS THIN LANCETS 26G","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"38396033070","LABEL_NAME":"LONGS THIN LANCETS 30G","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"38396034264","LABEL_NAME":"GNP UNIVERSAL 1 STANDARD 21G","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"38396034464","LABEL_NAME":"GNP UNIVERSAL 1 THIN 26G LANCT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"38396040102","LABEL_NAME":"RELION SYRING 0.3 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396040108","LABEL_NAME":"LEADER INS SYR 0.5 ML 28GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396040202","LABEL_NAME":"RELION SYRING 0.5 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396040208","LABEL_NAME":"LEADER INS SYR 1 ML 28GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396040212","LABEL_NAME":"MS INSULIN SYR 0.3 ML 29GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396040218","LABEL_NAME":"KRO INS SYR 0.3 ML 29GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396040302","LABEL_NAME":"RELION INS SYR 1 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396040308","LABEL_NAME":"LEADER INS SYR 0.3 ML 29GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396040318","LABEL_NAME":"KROGER INS SYR 0.5 ML 29GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396040325","LABEL_NAME":"KMART VALU PLUS SYR 1/2 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396040408","LABEL_NAME":"LEADER INS SYR 0.5 ML 29GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396040412","LABEL_NAME":"MS INS SYR 0.5 ML 29GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396040508","LABEL_NAME":"LEADER INS SYR 1 ML 29GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396040512","LABEL_NAME":"MS INS SYR 1 ML 29GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396040518","LABEL_NAME":"KROGER INS SYR 1 ML 29GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396040608","LABEL_NAME":"LEADER INSULIN SYRINGE 0.3 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396040612","LABEL_NAME":"MS INSULIN SYRINGE 0.3 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396040618","LABEL_NAME":"KRO INSULIN SYR 1 ML 30GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396040708","LABEL_NAME":"LEADER INS SYR 0.5 ML 30GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396040712","LABEL_NAME":"MS INSUL SYR 0.5 ML 30GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396040718","LABEL_NAME":"KROGER SYR 0.5 ML 30GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396040801","LABEL_NAME":"PREFERRED PLUS SYRINGE 0.5 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396040802","LABEL_NAME":"PREF PLUS INS 0.3 ML 29GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396040803","LABEL_NAME":"PREFERRED PLUS 0.5 ML 29GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396040804","LABEL_NAME":"PREFERRED PLUS SYRINGE 1 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396040805","LABEL_NAME":"PREF PLUS SYRING 1 ML 29GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396040806","LABEL_NAME":"PREFPLS INS SYR 1 ML 30GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396040807","LABEL_NAME":"PREF PLUS SYR 0.5 ML 30GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396040808","LABEL_NAME":"PREFERRED PLUS 0.3 ML 30GX5/16","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396040812","LABEL_NAME":"MS INS SYRINGE 1 ML 30GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396040818","LABEL_NAME":"KROGER INS SYR 0.3 ML 30GX5/16","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396040918","LABEL_NAME":"KROGER SYRING 0.3 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396041018","LABEL_NAME":"KRO INS SYRIN 0.5 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396041102","LABEL_NAME":"RELION INS SYR 0.3 ML 29GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396041118","LABEL_NAME":"KROGER INS SYR 1 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396041137","LABEL_NAME":"TOPCARE ULTRA COMFORT SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396041140","LABEL_NAME":"EQL INSULIN 0.3 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396041157","LABEL_NAME":"DRUG MART ULTRA COMFORT SYR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396041202","LABEL_NAME":"RELION INSULIN SYR 0.5 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396041237","LABEL_NAME":"TOPCARE ULTRA COMFORT SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396041240","LABEL_NAME":"EQL INSULIN 0.5 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396041302","LABEL_NAME":"RELION INS SYR 1 ML 29GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396041337","LABEL_NAME":"TOPCARE ULTRA COMFORT SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396041340","LABEL_NAME":"EQL INS SYR 1 ML 29GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396041357","LABEL_NAME":"DRUG MART ULTRA COMFORT SYR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396041557","LABEL_NAME":"DRUG MART ULTRA COMFORT SYR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396041640","LABEL_NAME":"EQL INSULIN 1 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396041808","LABEL_NAME":"LEADER INS SYR 1 ML 30GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396041908","LABEL_NAME":"LEADER SYRING 0.3 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396041940","LABEL_NAME":"EQL INSUL SYR 0.3 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396042008","LABEL_NAME":"LEADER SYRING 0.5 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396042040","LABEL_NAME":"EQL INSUL SYR 0.5 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396042108","LABEL_NAME":"LEADER INS SYR 1 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396042140","LABEL_NAME":"EQL INSULIN SYR 1 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396042912","LABEL_NAME":"MS INSUL SYR 0.3 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396043012","LABEL_NAME":"MS INSUL SYR 0.5 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396043112","LABEL_NAME":"MS INSULIN SYR 1 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396044164","LABEL_NAME":"GNP ULTRA COMFORT 0.5 ML SYR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396044464","LABEL_NAME":"GNP ULTRA COMFORT 1 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396044564","LABEL_NAME":"GNP INS SYR 0.3 ML 29GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396044864","LABEL_NAME":"GNP ULTRA COMFORT 3/10 ML SYR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396044902","LABEL_NAME":"RELION THIN 26G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"38396044964","LABEL_NAME":"GNP INSUL SYR 0.3 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396045064","LABEL_NAME":"GNP INSUL SYR 0.5 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396045164","LABEL_NAME":"GNP INSULIN SYR 1 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396045302","LABEL_NAME":"RELION ULTRA THIN 30G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"38396045339","LABEL_NAME":"SM INSUL SYR 0.3 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396045402","LABEL_NAME":"RELION ULTRA THIN 30G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"38396046339","LABEL_NAME":"SM INSUL SYR 0.5 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396047339","LABEL_NAME":"SM INSULIN SYR 1 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396050101","LABEL_NAME":"RELION LANCING DEVICE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"38396050232","LABEL_NAME":"WALGREENS THIN LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"38396050432","LABEL_NAME":"WALGREENS ULTRA THIN LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"38396051075","LABEL_NAME":"CVS LANCING DEVICE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"38396060118","LABEL_NAME":"KROGER LANCING DEVICE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"38396070339","LABEL_NAME":"SM LANCETS 21G","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"38396071339","LABEL_NAME":"SM THIN LANCETS 26G","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"38396072339","LABEL_NAME":"SM SUPER THIN 30G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"38396074339","LABEL_NAME":"SM COLOR LANCETS 21G","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"38396076339","LABEL_NAME":"SM INSULIN SYR 0.5 ML 28GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396077339","LABEL_NAME":"SM INS SYRINGE 1 ML 28GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396078339","LABEL_NAME":"SM INSULIN SYR 0.3 ML 29GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396079339","LABEL_NAME":"SM INS SYR 0.5 ML 29GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396080339","LABEL_NAME":"SM INS SYR 1 ML 29GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396081339","LABEL_NAME":"SM INS SYRING 0.3 ML 30GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396082339","LABEL_NAME":"SM INS SYR 0.5 ML 30GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38396083339","LABEL_NAME":"SM INS SYRINGE 1 ML 30GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38415000021","LABEL_NAME":"BULLSEYE MINI SAFETY 21G","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"38415000025","LABEL_NAME":"BULLSEYE MINI SAFETY 25G LANCT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"38415000028","LABEL_NAME":"BULLSEYE MINI SAFETY 28G LANCT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"38415000308","LABEL_NAME":"PEN NEEDLE 30G X 5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38415000315","LABEL_NAME":"PEN NEEDLE 31G X 3/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38415001630","LABEL_NAME":"INSULIN SYRINGE 1 ML 30GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38415003529","LABEL_NAME":"INSULIN SYRIN 0.3 ML 29GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38415003630","LABEL_NAME":"INSULIN SYR 0.3 ML 30GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38415005129","LABEL_NAME":"INSULIN SYRIN 1 ML 29GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38415005529","LABEL_NAME":"INSULIN SYRING 0.5 ML 29GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38415005630","LABEL_NAME":"INSULIN SYRIN 0.5 ML 30GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"38415010001","LABEL_NAME":"SAFETY-LET 30G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"38415010028","LABEL_NAME":"SAFETY SEAL 28G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"38415010030","LABEL_NAME":"SAFETY SEAL 30G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"38415030028","LABEL_NAME":"SAFETY SEAL 28G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"38415040028","LABEL_NAME":"EASY TWIST & CAP 28G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"38415051002","LABEL_NAME":"ALTERNATE SITE LANCING DEVICE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"38415051208","LABEL_NAME":"AQUA LANCE LANCING DEVICE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"39328000550","LABEL_NAME":"SOLUVITA A,C,D-FLUOR 0.25MG/ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"39328000750","LABEL_NAME":"SODIUM FLUORIDE 0.5 MG/ML DROP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"39328007920","LABEL_NAME":"FLAC OTIC OIL 0.01% EAR DROP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"39328009016","LABEL_NAME":"PREGABALIN 20 MG/ML SOLUTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"39328010610","LABEL_NAME":"PRENATAL VITAMIN PLUS LOW IRON","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"39328054416","LABEL_NAME":"CYPROHEPTADINE 2 MG/5 ML SOLN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"39328055750","LABEL_NAME":"FERROUS SULF 15 MG IRON/ML DRP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"40093010175","LABEL_NAME":"B-COMPLEX PLUS VITAMIN C CPLT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"40423050011","LABEL_NAME":"VIVAGUARD 30G LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"40423050013","LABEL_NAME":"VIVAGUARD LANCING DEVICE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"40423050018","LABEL_NAME":"VIVAGUARD SAFETY 28G LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"40423050021","LABEL_NAME":"CHOSEN LANCING DEVICE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"40423050022","LABEL_NAME":"CHOSEN 30G LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"40423050023","LABEL_NAME":"CHOSEN SAFETY 28G LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"41163005705","LABEL_NAME":"EQL INF IBUPROFEN 50 MG/1.25ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"41163019201","LABEL_NAME":"EQL ACETAMINOPHEN 500 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"41163023330","LABEL_NAME":"EQL SALINE 0.65% NASAL SPRAY","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"41163026606","LABEL_NAME":"EQL VITAMIN B-6 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"41163030601","LABEL_NAME":"EQL CLEARLAX POWDER","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"41163030603","LABEL_NAME":"EQL CLEARLAX POWDER","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"41163031916","LABEL_NAME":"EQL ANTI-ITCH 1% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"41163035926","LABEL_NAME":"EQL TUSSIN DM COUGH-CHEST SYR","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"41163037926","LABEL_NAME":"EQL CHILD ALLERGY 12.5 MG/5 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"41163045839","LABEL_NAME":"EQL ALL DAY ALLERGY 10 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"41163047164","LABEL_NAME":"EQL ANTI-ITCH 1% OINTMENT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"41163050001","LABEL_NAME":"EQL ACETAMINOPHEN 500 MG CPLT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"41163051402","LABEL_NAME":"EQL ACETAMINOPHEN 325 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"41163052001","LABEL_NAME":"EQL ACETAMINOPHEN 500 MG GELCP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"41163056306","LABEL_NAME":"EQL ASPIRIN EC 81 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"41163060462","LABEL_NAME":"EQL IBUPROFEN 200 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"41163060752","LABEL_NAME":"EQL GENTLE LAXATIVE EC 5 MG TB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"41163061265","LABEL_NAME":"EQL ALLERGY RELIEF 10 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"41163064771","LABEL_NAME":"EQL IBUPROFEN 200 MG CAPLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"41163068526","LABEL_NAME":"EQL CHILD IBUPROFEN 100 MG/5ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"41163070126","LABEL_NAME":"EQL TUSSIN MUCUS-CHEST CONGEST","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"41163079707","LABEL_NAME":"EQL ASPIRIN 81 MG CHEWABLE TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"41163098726","LABEL_NAME":"EQL CHILDREN'S COLD-COUGH LIQ","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"41250037926","LABEL_NAME":"CHILD'S ALLERGY 12.5 MG/5 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"41250037934","LABEL_NAME":"CHILD'S ALLERGY 12.5 MG/5 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"41250045875","LABEL_NAME":"24HOUR ALLERGY 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"41250047526","LABEL_NAME":"CHILD ALLERGY RELIEF 1 MG/ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"41415001573","LABEL_NAME":"PUB CHILD PAIN RLF 160 MG/5 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"41415001578","LABEL_NAME":"PUB INS SYRIN 0.3 ML 30GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"41415001778","LABEL_NAME":"PUB INSUL SYR 0.5 ML 30GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"41415001978","LABEL_NAME":"PUB INS SYRINGE 1 ML 30GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"41415002073","LABEL_NAME":"PUB IBUPROFEN 200 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"41415002078","LABEL_NAME":"PUB INSULIN SYR 1 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"41415002873","LABEL_NAME":"PUB ALLERGY 25 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"41415003973","LABEL_NAME":"PUB PAIN RELIEF 500 MG CAPLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"41415004775","LABEL_NAME":"PUB HYDROCREAM 1%","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"41415005073","LABEL_NAME":"PUB MILK OF MAGNESIA SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"41415005673","LABEL_NAME":"PUB PAIN RELIEF 500 MG GELTAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"41415007773","LABEL_NAME":"PUB DOCUSATE SODIUM 100 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"41415009773","LABEL_NAME":"PUB ALLERGY 12.5 MG/5 ML LIQ","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"41415009973","LABEL_NAME":"PUB TUSSIN DM LIQUID","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"41415010373","LABEL_NAME":"PUB CHILDREN'S PROFEN IB SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"41415011173","LABEL_NAME":"PUB ASPIRIN 81 MG CHEWABLE TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"41415014873","LABEL_NAME":"PUB INF PROFENIB 50 MG/1.25 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"41415017073","LABEL_NAME":"PUB MICONAZOLE3DAY COMBO PACK","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"41415018073","LABEL_NAME":"PUB LAXATIVE EC 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"41415021173","LABEL_NAME":"PUB ALLERGY RELIEF 10 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"41415021873","LABEL_NAME":"PUB TUSSIN 100 MG/5 ML SYRUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"41415022573","LABEL_NAME":"PUB CHILDREN'S PROFENIB SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"41415023273","LABEL_NAME":"PUB IBUPROFEN JR 100 MG CHEW","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"41415023873","LABEL_NAME":"PUB SALINE 0.65% NASAL SPRAY","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"41415025873","LABEL_NAME":"PUB STOP SMOKING AID 2 MG LOZG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"41415025973","LABEL_NAME":"PUB STOP SMOKING AID 4 MG LOZG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"41415027773","LABEL_NAME":"PUB CHILD'S DIBROMM DM LIQUID","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"41415028873","LABEL_NAME":"PUB ARTHRITIS PAIN ER 650 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"41415029173","LABEL_NAME":"PUB PAIN RELIEF 500 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"41415032573","LABEL_NAME":"PUB ALLERGY RELIEF 10 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"41415032873","LABEL_NAME":"PUB CHILDREN'S ALLERGY 1 MG/ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"41520051245","LABEL_NAME":"CAREONE SYR 0.3 ML 30GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"41520051255","LABEL_NAME":"CAREONE SYR 0.5 ML 30GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"41520051265","LABEL_NAME":"CAREONE SYR 1 ML 30GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"41616021990","LABEL_NAME":"KETOROLAC 0.5% OPHTH SOLUTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42037010313","LABEL_NAME":"ECOTRIN EC 81 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"42135010000","LABEL_NAME":"COMPACT SPACE CHAMBER","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42135010001","LABEL_NAME":"COMPACT SPACE CHAMBER-SM MASK","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42135010002","LABEL_NAME":"COMPACT SPACE CHAMBER-MED MASK","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42135010003","LABEL_NAME":"COMPACT SPACE CHAMBER-LRG MASK","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42167000552","LABEL_NAME":"RELIAMED 28G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"42167000554","LABEL_NAME":"RELIAMED 30G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"42167000556","LABEL_NAME":"RELIAMED MINI LANCING DEVICE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"42167000640","LABEL_NAME":"RELIAMED SAFETY SEAL 28G LANCT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"42167001090","LABEL_NAME":"RELIAMED SAFETY SEAL 30G LANCT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"42167001110","LABEL_NAME":"RELIAMED LANCING DEVICE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"42167003329","LABEL_NAME":"LANCETS ULTRA FINE 28G","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"42167003331","LABEL_NAME":"ADJUSTABLE LANCING DEVICE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"42192013608","LABEL_NAME":"SOD SULFACET-SULFUR 10-5% CLSR","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42192032090","LABEL_NAME":"PNV-SELECT TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42192032130","LABEL_NAME":"PNV-DHA SOFTGEL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42192032330","LABEL_NAME":"PNV-DHA + DOCUSATE SOFTGEL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42192032701","LABEL_NAME":"NP THYROID 15 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42192032801","LABEL_NAME":"NP THYROID 120 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42192032901","LABEL_NAME":"NP THYROID 30 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42192033001","LABEL_NAME":"NP THYROID 60 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42192033101","LABEL_NAME":"NP THYROID 90 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42192033230","LABEL_NAME":"PNV-OMEGA SOFTGEL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42192034130","LABEL_NAME":"PRENAISSANCE CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42192034330","LABEL_NAME":"PRENAISSANCE PLUS SOFTGEL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42195055014","LABEL_NAME":"CIPROFLOXACIN 0.2% OTIC SOLN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42227008101","LABEL_NAME":"CINRYZE 500 UNIT VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42227008301","LABEL_NAME":"CINRYZE 500 UNIT VIAL-DILUENT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42291007810","LABEL_NAME":"EZETIMIBE-SIMVASTATIN 10-10 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42291009430","LABEL_NAME":"AZELASTINE 0.1% (137 MCG) SPRY","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42291045160","LABEL_NAME":"DRONABINOL 10 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42291055328","LABEL_NAME":"NORGESTIMATE-EE 0.25-0.035 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42291056528","LABEL_NAME":"NORG-EE 0.18-0.215-0.25/0.025","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42291074151","LABEL_NAME":"SODIUM FLUORIDE 1.1% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42291093001","LABEL_NAME":"ZAFEMY 150-35 MCG/DAY PATCH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42291096208","LABEL_NAME":"YUVAFEM 10 MCG VAGINAL INSERT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42358029501","LABEL_NAME":"NULIBRY 9.5 MG VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42358045030","LABEL_NAME":"ZOKINVY 50 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42358047530","LABEL_NAME":"ZOKINVY 75 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42385092590","LABEL_NAME":"PIRFENIDONE 534 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42385092830","LABEL_NAME":"EFAVIR-LAMIV-TENOF 600-300-300","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42385092931","LABEL_NAME":"EFAVIR-LAMIV-TENOF 400-300-300","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42385094490","LABEL_NAME":"FENOFIBRIC ACID DR 45 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42388001114","LABEL_NAME":"COMETRIQ 140 MG DAILY-DOSE PK","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42388001214","LABEL_NAME":"COMETRIQ 100 MG DAILY-DOSE PK","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42388001314","LABEL_NAME":"COMETRIQ 60 MG DAILY-DOSE PACK","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42388002326","LABEL_NAME":"CABOMETYX 60 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42388002426","LABEL_NAME":"CABOMETYX 20 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42388002526","LABEL_NAME":"CABOMETYX 40 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42494042301","LABEL_NAME":"RIBAVIRIN 6 GM INHALATION VIAL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42494045310","LABEL_NAME":"NAPROXEN DR 375 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42494045410","LABEL_NAME":"NAPROXEN DR 500 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42507031026","LABEL_NAME":"HV TUSSIN MUCUS-CONG 200 MG/10","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"42507039640","LABEL_NAME":"HV MILK OF MAGNESIA SUSPENSION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"42543005261","LABEL_NAME":"NYSTATIN 100,000 UNIT/GM POWD","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42546018030","LABEL_NAME":"BAL-CARE DHA COMBO PACK","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42546031090","LABEL_NAME":"NEWGEN TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42546051730","LABEL_NAME":"PR NATAL 400 EC COMBO PACK","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42546051830","LABEL_NAME":"PR NATAL 430 EC COMBO PACK","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42546081130","LABEL_NAME":"PR NATAL 400 COMBO PACK","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42546081230","LABEL_NAME":"PR NATAL 430 COMBO PACK","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42571012821","LABEL_NAME":"BIMATOPROST 0.03% EYE DROPS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42571025001","LABEL_NAME":"CLINDAMYCIN HCL 75 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42571033201","LABEL_NAME":"METHENAMINE HIPP 1 GM TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42571038271","LABEL_NAME":"DORZOLAMIDE-TIMOLOL 2-0.5%(PF)","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42571038425","LABEL_NAME":"ERYTHROMYCIN 2% SOLUTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42571040421","LABEL_NAME":"TIMOLOL MALEATE 0.5% EYE DROPS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42747060290","LABEL_NAME":"NOURIANZ 20 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42747060490","LABEL_NAME":"NOURIANZ 40 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42794000308","LABEL_NAME":"ADEFOVIR DIPIVOXIL 10 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42794001610","LABEL_NAME":"ASENAPINE 5 MG TABLET SL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42794001710","LABEL_NAME":"ASENAPINE 10 MG TABLET SL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42794002908","LABEL_NAME":"DISULFIRAM 500 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42794008614","LABEL_NAME":"SODIUM PHENYLBUTYRATE POWDER","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42794013112","LABEL_NAME":"LIOMNY 5 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42794013212","LABEL_NAME":"LIOMNY 25 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42794013312","LABEL_NAME":"LIOMNY 50 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42799010501","LABEL_NAME":"METHENAMINE MAND 500 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42799010601","LABEL_NAME":"METHENAMINE MAND 1 GM TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42799011101","LABEL_NAME":"ETODOLAC 400 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42799011201","LABEL_NAME":"ETODOLAC 500 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42799020701","LABEL_NAME":"TINIDAZOLE 250 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42799020801","LABEL_NAME":"TINIDAZOLE 500 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42799040501","LABEL_NAME":"ETHACRYNIC ACID 25 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42799070915","LABEL_NAME":"YARGESA 100 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42799080601","LABEL_NAME":"IVERMECTIN 3 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42799081601","LABEL_NAME":"PREDNISOLONE SOD PH 25 MG/5 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42799093501","LABEL_NAME":"DOXEPIN 150 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42799095301","LABEL_NAME":"DICLOFENAC SOD ER 100 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42806005030","LABEL_NAME":"MEPERIDINE 50 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42806018615","LABEL_NAME":"KLAYESTA 100,000 UNIT/GM POWD","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42806075760","LABEL_NAME":"SULFADIAZINE 500 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42858030416","LABEL_NAME":"HYDROMORPHONE 5 MG/5 ML SOLN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42858070101","LABEL_NAME":"THEOPHYLLINE ER 400 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"42937070510","LABEL_NAME":"PRENATAL PLUS IRON TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"43068030402","LABEL_NAME":"HETLIOZ LQ 4 MG/ML SUSPENSION","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"43292055515","LABEL_NAME":"PRENATAL TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"43292055705","LABEL_NAME":"ALER-CAPS 25 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"43292056437","LABEL_NAME":"MUCOSA 400 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"43376032230","LABEL_NAME":"FINTEPLA 2.2 MG/ML SOLUTION","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"43386005019","LABEL_NAME":"GAVILYTE-N SOLUTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"43386006019","LABEL_NAME":"GAVILYTE-C SOLUTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"43386009019","LABEL_NAME":"GAVILYTE-G SOLUTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"43386028001","LABEL_NAME":"DIAZEPAM 10MG RECTAL GEL (2PK)","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"43386028003","LABEL_NAME":"DIAZEPAM 10 MG RECTAL GEL SYRG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"43386028101","LABEL_NAME":"DIAZEPAM 20MG RECTAL GEL (2PK)","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"43386028103","LABEL_NAME":"DIAZEPAM 20 MG RECTAL GEL SYRG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"43386031208","LABEL_NAME":"GAVILAX POWDER","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"43528000301","LABEL_NAME":"HEPLISAV-B 20 MCG/0.5 ML SYRNG","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"43538017069","LABEL_NAME":"CLINDACIN P 1% PLEDGETS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"43538017260","LABEL_NAME":"CLINDACIN ETZ 1% PLEDGET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"43538017645","LABEL_NAME":"NEUAC GEL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"43538018045","LABEL_NAME":"ROSADAN 0.75% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"43538018245","LABEL_NAME":"ROSADAN 0.75% GEL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"43538050006","LABEL_NAME":"CICLODAN 8% SOLUTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"43538052090","LABEL_NAME":"CICLODAN 0.77% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"43547034506","LABEL_NAME":"LEVETIRACETAM ER 500 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"43547034606","LABEL_NAME":"LEVETIRACETAM ER 750 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"43547038609","LABEL_NAME":"FOSINOPRIL SODIUM 10 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"43547038709","LABEL_NAME":"FOSINOPRIL SODIUM 20 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"43547038809","LABEL_NAME":"FOSINOPRIL SODIUM 40 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"43547041009","LABEL_NAME":"QUINAPRIL 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"43547041109","LABEL_NAME":"QUINAPRIL 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"43547041209","LABEL_NAME":"QUINAPRIL 20 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"43547041309","LABEL_NAME":"QUINAPRIL 40 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"43547055210","LABEL_NAME":"POTASSIUM CL ER 8 MEQ CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"43547098510","LABEL_NAME":"NITROGLYCERIN 0.3 MG TABLET SL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"43547098604","LABEL_NAME":"NITROGLYCERIN 0.4 MG TABLET SL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"43547098710","LABEL_NAME":"NITROGLYCERIN 0.6 MG TABLET SL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"43598005504","LABEL_NAME":"NILOTINIB HCL 50 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"43598013101","LABEL_NAME":"HYDROXYCHLOROQUINE 400 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"43598013201","LABEL_NAME":"HYDROXYCHLOROQUINE 300 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"43598013301","LABEL_NAME":"HYDROXYCHLOROQUINE 100 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"43598021025","LABEL_NAME":"SSD 1% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"43598044556","LABEL_NAME":"NICOTINE TRANSDERMAL SYSTEM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"43598049401","LABEL_NAME":"NAPROXEN SODIUM 275 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"43598049501","LABEL_NAME":"NAPROXEN SODIUM 550 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"43598076811","LABEL_NAME":"SUMATRIPTAN 6 MG/0.5ML AUTOINJ","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"43598093109","LABEL_NAME":"DESMOPRESSIN AC 4 MCG/ML AMPUL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"43684020020","LABEL_NAME":"AVIDOXY 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"43820000008","LABEL_NAME":"ULTI-LANCE AUTO-AD DEVICE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"43820000009","LABEL_NAME":"ULTI-LANCE AUTOMATIC DEVICE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"44087000401","LABEL_NAME":"SEROSTIM 4 MG VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"44087000501","LABEL_NAME":"SEROSTIM 5 MG VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"44087000601","LABEL_NAME":"SEROSTIM 6 MG VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"44087115001","LABEL_NAME":"OVIDREL 250 MCG/0.5 ML SYRG","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"44087500003","LABEL_NAME":"TEPMETKO 225 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"44224006772","LABEL_NAME":"NATRAPEL 20% SPRAY","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"44224006878","LABEL_NAME":"NATRAPEL 20% SPRAY","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"44229051047","LABEL_NAME":"VORTEX HOLDING CHAMBER","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"44229051049","LABEL_NAME":"VORTEX VHC PEDIATRIC MED MASK","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"44523082501","LABEL_NAME":"CARBINOXAMINE MALEATE 4 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"44946100803","LABEL_NAME":"LUDENT FLUORIDE 0.25 MG TB CHW","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"44946100903","LABEL_NAME":"LUDENT FLUORIDE 0.5 MG TB CHEW","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"44946101003","LABEL_NAME":"LUDENT FLUORIDE 1 MG TAB CHEW","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"44946102005","LABEL_NAME":"MVC-FLUORIDE 0.25 MG TAB CHEW","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"44946102105","LABEL_NAME":"MVC-FLUORIDE 0.5 MG TAB CHEW","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"44946102205","LABEL_NAME":"MVC-FLUORIDE 1 MG TAB CHEW","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"44946103508","LABEL_NAME":"TRI-VIT-FLUOR 0.25 MG/ML DROP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"44946103608","LABEL_NAME":"TRI-VIT-FLUOR 0.5 MG/ML DROP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"44946104501","LABEL_NAME":"PNV PRENATAL PLUS MULTIVIT TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"44946201708","LABEL_NAME":"MULTIVIT-FLUOR 0.25 MG/ML DROP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"44946201808","LABEL_NAME":"MULTIVIT-FLUOR 0.5 MG/ML DROP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"45629008901","LABEL_NAME":"FOTIVDA 0.89 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"45629013401","LABEL_NAME":"FOTIVDA 1.34 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"45802000910","LABEL_NAME":"FLUOCINOLONE OIL 0.01% EAR DRP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"45802004064","LABEL_NAME":"SELENIUM SULFIDE 2.5% LOTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"45802004201","LABEL_NAME":"CLINDESSE 2% VAGINAL CREAM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"45802007830","LABEL_NAME":"BRIMONIDINE 0.33% GEL PUMP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"45802010196","LABEL_NAME":"BENZOYL PEROXIDE 2.5% GEL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"45802010401","LABEL_NAME":"OLOPATADINE 665 MCG NASAL SPRY","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"45802010901","LABEL_NAME":"TRIAMCINOLONE 55 MCG NASAL SPR","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"45802011101","LABEL_NAME":"DICLOFENAC SODIUM 3% GEL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"45802014464","LABEL_NAME":"HYDROCORT-PRAMOXINE 1%-1% CRM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"45802026337","LABEL_NAME":"CLINDAMYCIN PHOS 1% PLEDGET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"45802036800","LABEL_NAME":"IMIQUIMOD 5% CREAM PACKET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"45802037632","LABEL_NAME":"BETAMETHASONE DP AUG 0.05% CRM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"45802040046","LABEL_NAME":"CICLOPIROX 0.77% TOPICAL SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"45802043321","LABEL_NAME":"DEXTROMETHORPHAN ER 30 MG/5 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"45802046611","LABEL_NAME":"ECONAZOLE NITRATE 1% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"45802048526","LABEL_NAME":"FLUOCINOLONE 0.01% SCALP OIL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"45802049535","LABEL_NAME":"DESOXIMETASONE 0.25% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"45802049614","LABEL_NAME":"DESOXIMETASONE 0.25% OINTMENT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"45802062701","LABEL_NAME":"BUDESONIDE 2 MG RECTAL FOAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"45802063732","LABEL_NAME":"CLOBETASOL EMOLLNT 0.05% FOAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"45802073030","LABEL_NAME":"ACETAMINOPHEN 650 MG SUPPOS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"45802073200","LABEL_NAME":"ACETAMINOPHEN 120 MG SUPPOS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"45802088726","LABEL_NAME":"FLUOCINOLONE 0.01% BODY OIL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"45802089626","LABEL_NAME":"SULFACETAMIDE SOD 10% TOP SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"45802093716","LABEL_NAME":"HYDROCORTISONE 2.5% LOTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"45802096272","LABEL_NAME":"ERY 2% PADS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"45802096694","LABEL_NAME":"ERYTHROMYCIN 2% GEL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"45963043864","LABEL_NAME":"ENULOSE 10 GM/15 ML SOLUTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"45963043963","LABEL_NAME":"CONSTULOSE 10 GM/15 ML SOLN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"46036000085","LABEL_NAME":"GS IBUPROFEN 200 MG SOFTGEL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"46122001452","LABEL_NAME":"CLEARLAX POWDER PACKET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"46122005762","LABEL_NAME":"TUSSIN 400 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"46122005862","LABEL_NAME":"TUSSIN DM 400-20 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"46122006271","LABEL_NAME":"8 HOUR ACETAMINOPHEN ER 650 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"46122009878","LABEL_NAME":"GNP PRENATAL TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"46122014762","LABEL_NAME":"ALLERGY 25 MG SOFTGEL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"46122022163","LABEL_NAME":"GLYCERIN SUPPOSITORY","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"46122028460","LABEL_NAME":"GNP NICOTINE 2 MG CHEWING GUM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"46122029934","LABEL_NAME":"GNP TUSSIN MUCUS-CON 200 MG/10","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"46122035626","LABEL_NAME":"ALLERGY 50 MG/20 ML SOLUTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"46122038576","LABEL_NAME":"24H NASAL ALLERGY 55 MCG SPRAY","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"46122042462","LABEL_NAME":"GNP CHILD PAIN RELIEF 160 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"46122042963","LABEL_NAME":"WOMEN'S GENTLE LAX EC 5 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"46122043078","LABEL_NAME":"ACETAMINOPHEN 325 MG GELCAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"46122044427","LABEL_NAME":"GNP MICONAZORB AF 2% POWDER","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"46122044958","LABEL_NAME":"GNP NICOTINE 4 MG CHEWING GUM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"46122052963","LABEL_NAME":"GNP GENTLE LAXATIVE EC 5 MG TB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"46122054890","LABEL_NAME":"GNP IBUPROFEN 200 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"46122056803","LABEL_NAME":"GNP NICOTINE 21 MG/24HR PATCH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"46122058055","LABEL_NAME":"GNP IBUPROFEN 200 MG SOFTGEL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"46122059341","LABEL_NAME":"GNP IBUPROFEN 200 MG MINI SFGL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"46122059848","LABEL_NAME":"GNP ASPIRIN EC 81 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"46122062962","LABEL_NAME":"GNP 8HR ARTHRIT PAIN ER 650 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"46122063071","LABEL_NAME":"GNP 8 HOUR PAIN RLF ER 650 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"46122063078","LABEL_NAME":"GNP 8 HOUR PAIN RELIEF 650 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"46122065162","LABEL_NAME":"GNP SLEEP AID 25 MG CAPLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"46122066315","LABEL_NAME":"GNP NICOTINE 2 MG MINI LOZENGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"46122066515","LABEL_NAME":"GNP NICOTINE 4 MG MINI LOZENGE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"46122067127","LABEL_NAME":"GNP OLOPATADINE 0.2% EYE DROP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"46122068429","LABEL_NAME":"GNP FLUTICASONE PROP 50 MCG SP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"46122069662","LABEL_NAME":"GNP PAIN RELIEF 500 MG GELCAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"46122069962","LABEL_NAME":"GNP ALLERGY RELIEF 25 MG SFGL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"46122070426","LABEL_NAME":"GNP TUSSIN DM 200-20 MG/20 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"46122071560","LABEL_NAME":"GNP NICOTINE 2 MG MINI LOZENGE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"46122071615","LABEL_NAME":"GNP NICOTINE 4 MG MINI LOZENGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"46122073208","LABEL_NAME":"GNP NICOTINE 4 MG LOZENGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"46122073408","LABEL_NAME":"GNP NICOTINE 2 MG LOZENGE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"46122074038","LABEL_NAME":"GNP MAGNESIUM CITRATE SOLUTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"46122076351","LABEL_NAME":"GNP SLEEP AID 25 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"46122076434","LABEL_NAME":"GNP INFANT PAIN-FEVER 160 MG/5","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"46122076836","LABEL_NAME":"GNP ADAPALENE 0.1% GEL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"46122078734","LABEL_NAME":"GNP CHILD LORATADINE 5 MG/5 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"46122078815","LABEL_NAME":"GNP NIGHTTIME SLEEP 25 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"46122079329","LABEL_NAME":"GNP CHILD ALLERGY 12.5 MG/5 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"46122080529","LABEL_NAME":"GNP CLEARLAX POWDER","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"46287000601","LABEL_NAME":"SPS 15 GM/60 ML SUSPENSION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"46287000604","LABEL_NAME":"SPS 30 GM/120 ML ENEMA SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"46287000901","LABEL_NAME":"ISONIAZID 50 MG/5 ML SOLUTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"46287004515","LABEL_NAME":"TADLIQ 20 MG/5 ML SUSPENSION","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"46500001810","LABEL_NAME":"OFF ACTIVE 15% SPRAY","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"46500001828","LABEL_NAME":"OFF FAMILYCARE 5% REPELLNT III","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"46500001835","LABEL_NAME":"OFF FAMILYCARE 7% RPLNT SPRAY","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"46500001842","LABEL_NAME":"OFF DEEP WOODS 25% SPRAY","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"46500001849","LABEL_NAME":"OFF DEEP WOODS SPORTMN 98.25%","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"46500021845","LABEL_NAME":"OFF DEEP WOODS 25% SPRAY","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"46500022154","LABEL_NAME":"OFF FAMILYCARE 15% RPLNT I SPR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"46500054996","LABEL_NAME":"OFF DEEP WOODS 25% TOWELETTE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"46500061851","LABEL_NAME":"OFF DEEP WOODS SPORTMN 30% SPR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"46500071764","LABEL_NAME":"OFF DEEP WOODS DRY 25% SPRAY","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"46500071787","LABEL_NAME":"OFF DEEP WOODS SPORTMN 25% SPR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"46500072616","LABEL_NAME":"OFF FAMILYCARE 7% RPLNT SPRAY","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"46500081881","LABEL_NAME":"OFF FAMILYCARE 5% RPLNT II SPR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"47335010886","LABEL_NAME":"LEQSELVI 8 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"47335017795","LABEL_NAME":"ILUMYA 100 MG/ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"47335030788","LABEL_NAME":"ZOLPIDEM TART ER 6.25 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"47335030888","LABEL_NAME":"ZOLPIDEM TART ER 12.5 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"47335040181","LABEL_NAME":"YONSA 125 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"47335053183","LABEL_NAME":"TRAMADOL ER 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"47335053383","LABEL_NAME":"TRAMADOL ER 200 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"47335053783","LABEL_NAME":"TRAMADOL ER 300 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"47335066913","LABEL_NAME":"DILTIAZEM 24HR ER 120 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"47335067013","LABEL_NAME":"DILTIAZEM 24HR ER 180 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"47335067113","LABEL_NAME":"DILTIAZEM 24HR ER 240 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"47335067213","LABEL_NAME":"DILTIAZEM 24HR ER 300 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"47335067313","LABEL_NAME":"DILTIAZEM 24HR ER 360 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"47335078891","LABEL_NAME":"DESMOPRESSIN 10 MCG/0.1 ML SPR","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"47335093890","LABEL_NAME":"AZELASTINE HCL 0.05% DROPS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"47360001722","LABEL_NAME":"MICROCHAMBER","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"47682020312","LABEL_NAME":"LORADAMED 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"47682025303","LABEL_NAME":"AMINOFEN 325 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"47682025314","LABEL_NAME":"ADDAPRIN 200 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"47682080313","LABEL_NAME":"NON-ASPIRIN 325 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"47682080413","LABEL_NAME":"NON-ASPIRIN 500 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"47781039260","LABEL_NAME":"HYDROCODONE ER 20 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"47781039360","LABEL_NAME":"HYDROCODONE ER 30 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"47781039460","LABEL_NAME":"HYDROCODONE ER 40 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"47781039560","LABEL_NAME":"HYDROCODONE ER 60 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"47781039660","LABEL_NAME":"HYDROCODONE ER 80 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"47781039760","LABEL_NAME":"HYDROCODONE ER 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"47781039860","LABEL_NAME":"HYDROCODONE ER 120 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"47781040960","LABEL_NAME":"HYDROCODONE ER 10 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"47781041060","LABEL_NAME":"HYDROCODONE ER 15 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"47781041160","LABEL_NAME":"HYDROCODONE ER 20 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"47781041260","LABEL_NAME":"HYDROCODONE ER 30 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"47781041360","LABEL_NAME":"HYDROCODONE ER 40 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"47781041460","LABEL_NAME":"HYDROCODONE ER 50 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"47783064501","LABEL_NAME":"TAKHZYRO 150 MG/ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"47783064601","LABEL_NAME":"TAKHZYRO 300 MG/2 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"49022008436","LABEL_NAME":"CLOTRIMAZOLE-7 VAGINAL CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"49022031003","LABEL_NAME":"SCALP RELIEF LIQUID","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"49022059840","LABEL_NAME":"ACNE TREATMENT 10% GEL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"49022067498","LABEL_NAME":"ACNE FOAMING 10% WASH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"49035002419","LABEL_NAME":"EQ ALLERGY RELIEF 1 MG/ML SOLN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"49035002996","LABEL_NAME":"EQ NICOTINE 2 MG CHEWING GUM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"49035004226","LABEL_NAME":"EQ CHLD PAIN-FEVER 160 MG/5 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"49035006108","LABEL_NAME":"EQ CHILD ALLERGY 5 MG/5 ML SOL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"49035008234","LABEL_NAME":"EQ CHILDREN COLD-COUGH ELIXIR","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"49035010104","LABEL_NAME":"EQ CHILD ALLERGY 12.5 MG/5 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"49035010608","LABEL_NAME":"EQ CHILD ALLERGY RELF 1 MG/ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"49035012409","LABEL_NAME":"EQ NICOTINE 2 MG LOZENGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"49035012410","LABEL_NAME":"EQ NICOTINE 2 MG LOZENGE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"49035012524","LABEL_NAME":"EQ INF IBUPROFEN 50 MG/1.25 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"49035012694","LABEL_NAME":"EQ CHILD IBUPROFEN 100 MG/5 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"49035017029","LABEL_NAME":"EQ NICOTINE 4 MG CHEWING GUM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"49035018380","LABEL_NAME":"EQ CHILD ALLERGY RELIEF SOLN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"49035019008","LABEL_NAME":"EQ ALLERGY RELIEF 25 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"49035019010","LABEL_NAME":"EQ NICOTINE 4 MG LOZENGE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"49035019401","LABEL_NAME":"EQ NICOTINE 21 MG/24HR PATCH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"49035019502","LABEL_NAME":"EQ NICOTINE 14 MG/24HR PATCH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"49035019602","LABEL_NAME":"EQ NICOTINE 7 MG/24HR PATCH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"49035020001","LABEL_NAME":"EQ ALLERGY RELIEF 50 MCG SPRAY","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"49035027408","LABEL_NAME":"EQ ASPIRIN 81 MG CHEWABLE TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"49035027609","LABEL_NAME":"EQ CHILD CETIRIZINE 1 MG/ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"49035027808","LABEL_NAME":"EQ PAIN RELIEF 500 MG/15 ML LQ","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"49035030601","LABEL_NAME":"EQ CLEARLAX POWDER","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"49035030603","LABEL_NAME":"EQ CLEARLAX POWDER","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"49035030882","LABEL_NAME":"EQ PAIN RELIEVER 500 MG CAPLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"49035032712","LABEL_NAME":"EQ GENTLE LAXATIVE DR 5 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"49035032910","LABEL_NAME":"EQ MAGNESIUM CITRATE SOLUTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"49035034190","LABEL_NAME":"EQ ATHLETE'S FOOT 2% PWD SPRAY","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"49035035926","LABEL_NAME":"EQ TUSSIN DM COUGH-CHEST SYR","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"49035036964","LABEL_NAME":"EQ HYDROCORTISONE 1% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"49035038421","LABEL_NAME":"EQ COUGH DM ER 30 MG/5 ML SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"49035041412","LABEL_NAME":"EQ ASPIRIN EC 81 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"49035044301","LABEL_NAME":"EQ NASAL ALLERGY 24HR SPRAY","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"49035045866","LABEL_NAME":"EQ ALLERGY RELIEF 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"49035048462","LABEL_NAME":"EQ ACETAMINOPHEN 500 MG CAPLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"49035049101","LABEL_NAME":"EQ PAIN RELIEVER 325 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"49035051908","LABEL_NAME":"EQ ACETAMINOPHEN 500 MG GELCAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"49035052162","LABEL_NAME":"EQ IBUPROFEN JR STR 100 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"49035053112","LABEL_NAME":"EQ ACETAMINOPHEN 500 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"49035054485","LABEL_NAME":"EQ ARTHRITIS PAIN ER 650 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"49035059016","LABEL_NAME":"EQ INFANT PAIN-FEVER 160 MG/5","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"49035060458","LABEL_NAME":"EQ IBUPROFEN 200 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"49035061246","LABEL_NAME":"EQ ALLERGY (LORAT) 10 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"49035064782","LABEL_NAME":"EQ IBUPROFEN 200 MG CAPLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"49035070301","LABEL_NAME":"EQ BUDESONIDE 32 MCG SPRAY","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"49035073007","LABEL_NAME":"EQ MICONAZOLE 2% VAGINAL CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"49035073401","LABEL_NAME":"EQ NICOTINE 2 MG MINI LOZENGE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"49035074101","LABEL_NAME":"EQ 8HR ARTHRITIS PAIN ER 650MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"49035082529","LABEL_NAME":"EQ MICONAZOLE 7 CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"49035090603","LABEL_NAME":"MIX-IN LAXATIVE POWDER PACKET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"49035091920","LABEL_NAME":"EQ PAIN RELIEVER 500 MG GELCAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"49035092835","LABEL_NAME":"EQ TERBINAFINE 1% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"49281012565","LABEL_NAME":"FLUZONE HIGH-DOSE 2025-26 SYR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"49281021510","LABEL_NAME":"TENIVAC VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"49281021515","LABEL_NAME":"TENIVAC SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"49281028610","LABEL_NAME":"DAPTACEL DTAP VACCINE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"49281040010","LABEL_NAME":"ADACEL TDAP VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"49281040020","LABEL_NAME":"ADACEL TDAP SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"49281042550","LABEL_NAME":"FLUZONE 2025-2026 SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"49281051105","LABEL_NAME":"PENTACEL VIAL KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"49281054503","LABEL_NAME":"ACTHIB VACCINE WITH DILUENT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"49281054758","LABEL_NAME":"ACTHIB VACCINE VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"49281056210","LABEL_NAME":"QUADRACEL DTAP-IPV VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"49281056410","LABEL_NAME":"QUADRACEL DTAP-IPV VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"49281056415","LABEL_NAME":"QUADRACEL DTAP-IPV SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"49281059005","LABEL_NAME":"MENQUADFI VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"49281064315","LABEL_NAME":"FLUZONE 2025-2026 VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"49281072510","LABEL_NAME":"FLUBLOK 2025-2026 SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"49348035684","LABEL_NAME":"SM SALINE 0.65% NASAL SPRAY","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"49348075707","LABEL_NAME":"SM ASPIRIN 81 MG CHEWABLE TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"49401008801","LABEL_NAME":"BENLYSTA 200 MG/ML AUTOINJECT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"49401008842","LABEL_NAME":"BENLYSTA 200 MG/ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"49483000301","LABEL_NAME":"LAXATIVE EC 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"49483061701","LABEL_NAME":"NAPROXEN 375 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"49483061801","LABEL_NAME":"NAPROXEN 500 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"49483061901","LABEL_NAME":"NAPROXEN 250 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"49483068201","LABEL_NAME":"ALLERGY RLF (CETRZN) 5 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"49483068703","LABEL_NAME":"PARICALCITOL 1 MCG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"49483068803","LABEL_NAME":"PARICALCITOL 2 MCG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"49483068903","LABEL_NAME":"PARICALCITOL 4 MCG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"49483069250","LABEL_NAME":"ALLERGY RLF (CETRZN) 10 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"49502020701","LABEL_NAME":"EASIVENT HOLDING CHAMBER","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"49502020801","LABEL_NAME":"EASIVENT MASK-SMALL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"49502020802","LABEL_NAME":"EASIVENT MASK-MEDIUM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"49502020803","LABEL_NAME":"EASIVENT MASK-LARGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"49502045093","LABEL_NAME":"CIMDUO 300-300 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"49502047626","LABEL_NAME":"PRETOMANID 200 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"49702022813","LABEL_NAME":"TIVICAY 50 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"49702023113","LABEL_NAME":"TRIUMEQ 600-50-300 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"49702024213","LABEL_NAME":"JULUCA 50-25 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"49702024613","LABEL_NAME":"DOVATO 50-300 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"49702025018","LABEL_NAME":"RUKOBIA ER 600 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"49702025537","LABEL_NAME":"TIVICAY PD 5 MG TAB FOR SUSP","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"49702025837","LABEL_NAME":"TRIUMEQ PD 60-5-30 MG TAB SUSP","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"49702026055","LABEL_NAME":"SELZENTRY 20 MG/ML ORAL SOLN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"49884016111","LABEL_NAME":"CALCITONIN-SALMON 200 UNIT SPR","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"49884017004","LABEL_NAME":"SODIUM PHENYLBUTYRATE 500MG TB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"49884023183","LABEL_NAME":"PRAZIQUANTEL 600 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"49884026495","LABEL_NAME":"GLYCEROL PHENYLBUT 1.1 GRAM/ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"49884030602","LABEL_NAME":"CLONAZEPAM 0.125 MG DIS TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"49884030802","LABEL_NAME":"CLONAZEPAM 0.5 MG DIS TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"49884030902","LABEL_NAME":"CLONAZEPAM 1 MG DIS TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"49884034701","LABEL_NAME":"PIMOZIDE 1 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"49884034801","LABEL_NAME":"PIMOZIDE 2 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"49884041301","LABEL_NAME":"URSODIOL 500 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50001046210","LABEL_NAME":"GOJJI LANCING DEVICE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50001046235","LABEL_NAME":"GOJJI LANCETS 30G","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50001080575","LABEL_NAME":"CHILD ALLERGY 12.5 MG/5 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50002086019","LABEL_NAME":"COMFORT EZ INS 1 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50002086020","LABEL_NAME":"COMFORT EZ INS 0.5ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50002086045","LABEL_NAME":"CLEVER CHOICE CHAMBER-SM MASK","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50002086046","LABEL_NAME":"CLEVER CHOICE CHAMBER-MED MASK","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50002086047","LABEL_NAME":"CLEVER CHOICE CHAMBER-LRG MASK","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50002086060","LABEL_NAME":"ULTRA THIN 31G LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50003021300","LABEL_NAME":"RANGER READY REPELLENT 20% SPR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50011083312","LABEL_NAME":"VERIFINE SAFETY 28G LANCT MINI","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50011083313","LABEL_NAME":"VERIFINE SAFETY 30G LANCT MINI","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50011083323","LABEL_NAME":"VERIFINE SAFETY 21G LANCT MINI","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50011083333","LABEL_NAME":"VERIFINE SAFETY 23G LANCT MINI","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50011083344","LABEL_NAME":"VERIFINE UNIVERSAL 33G LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50011083350","LABEL_NAME":"VERIFINE UNIVERSAL 30G LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50011083355","LABEL_NAME":"VERIFINE INS SYR 0.3ML 31G 8MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50011083357","LABEL_NAME":"VERIFINE INS SYR 0.5ML 31G 8MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50011083358","LABEL_NAME":"VERIFINE INS SYR 1 ML 29G 12MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50011083360","LABEL_NAME":"VERIFINE UNIVERSAL 28G LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50011083375","LABEL_NAME":"VERIFINE SYRNG 0.3ML 31G 5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50011083376","LABEL_NAME":"VERIFINE SYRING 0.5ML 29G 1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50011083377","LABEL_NAME":"VERIFINE SYRNG 0.5ML 31G 5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50011083378","LABEL_NAME":"VERIFINE INS SYR 1 ML 29G 1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50011083379","LABEL_NAME":"VERIFINE SYRING 1 ML 31G 5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50011083384","LABEL_NAME":"VERIFINE INS SYR 1 ML 31G 8MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50011083385","LABEL_NAME":"VERIFINE IN SYR 0.5ML 29G 12MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50027049409","LABEL_NAME":"TRUE COMFORT PRO 1ML 31G 5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50027049410","LABEL_NAME":"TRUE CMFRT PRO 0.5ML 31G 5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50027049411","LABEL_NAME":"TRUE CMFRT PRO 0.5ML 32G 5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50027049413","LABEL_NAME":"TRUE COMFORT 30G TWIST LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50027049414","LABEL_NAME":"TRUE COMFORT PRO 1ML 32G 5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50027049415","LABEL_NAME":"TRUE COMFORT PRO 1ML 30G 5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50027049416","LABEL_NAME":"TRUE CMFRT PRO 0.5ML 30G 5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50027049417","LABEL_NAME":"TRUE COMFRT PRO 0.5ML 30G 1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50027049418","LABEL_NAME":"TRUE COMFORT PRO 1 ML 30G 1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50027049441","LABEL_NAME":"PURE COMFORT SPACER-ADULT MASK","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50027049446","LABEL_NAME":"SAPS TWIST TOP 30G LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50027049454","LABEL_NAME":"PRO COMFORT 30G SAFETY LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50027049465","LABEL_NAME":"EASY COMFORT 0.3 ML 31G 5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50027049466","LABEL_NAME":"EASY COMFORT 0.3 ML 31G 1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50027049486","LABEL_NAME":"TRUE COMFORT 0.5 ML 30G 1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50027049487","LABEL_NAME":"TRUE COMFORT SFTY 1ML 30G 1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50027049488","LABEL_NAME":"TRUE COMFORT 0.5ML 30G 5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50027049489","LABEL_NAME":"TRUE COMFRT SFTY 1ML 30G 5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50027049490","LABEL_NAME":"TRUE COMFORT 0.5ML 31G 5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50027049491","LABEL_NAME":"TRUE COMFRT SFTY 1ML 31G 5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50027049492","LABEL_NAME":"TRUE COMFRT SFTY 1ML 32G 5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50033087945","LABEL_NAME":"ADVOCATE SAFETY 21G LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50033087946","LABEL_NAME":"ADVOCATE SAFETY 23G LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50033087947","LABEL_NAME":"ADVOCATE SAFETY 28G LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50058086403","LABEL_NAME":"PRO COMFORT 1 ML 30G 5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50058086404","LABEL_NAME":"PRO COMFORT 0.5 ML 30G 5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50058086405","LABEL_NAME":"PRO COMFORT 0.5 ML 31G 5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50058086406","LABEL_NAME":"PRO COMFORT 1 ML 31G 5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50058086415","LABEL_NAME":"EASY COMFORT SYR 1 ML 29G 8MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50058086416","LABEL_NAME":"EASY COMFORT SYR 0.5ML 29G 8MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50070097932","LABEL_NAME":"FONDCIRCLE LANCING DEVICE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50070097933","LABEL_NAME":"FONDCIRCLE 30G LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50071076508","LABEL_NAME":"PURE COMFORT 30G SAFETY LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50081000303","LABEL_NAME":"MYGLUCOHEALTH 30G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50102010001","LABEL_NAME":"LYZA 0.35 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50102011101","LABEL_NAME":"ECONTRA EZ 1.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50102012001","LABEL_NAME":"AUBRA-28 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50102012801","LABEL_NAME":"TARINA FE 1-20 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50102015401","LABEL_NAME":"CYRED 28 DAY TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50102020011","LABEL_NAME":"TULANA 0.35 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50102021111","LABEL_NAME":"ECONTRA ONE-STEP 1.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50102022021","LABEL_NAME":"AUBRA EQ-28 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50102022421","LABEL_NAME":"TARINA 24 FE 1 MG-20 MCG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50102022821","LABEL_NAME":"TARINA FE 1-20 EQ TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50102023021","LABEL_NAME":"CHATEAL EQ-28 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50102023101","LABEL_NAME":"TRI-VYLIBRA LO TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50102023311","LABEL_NAME":"TRI-VYLIBRA 28 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50102023511","LABEL_NAME":"VYLIBRA 28 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50102024021","LABEL_NAME":"JASMIEL 3 MG-0.02 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50102025421","LABEL_NAME":"CYRED EQ 28 DAY TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50102030001","LABEL_NAME":"LYLEQ 0.35 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50222034602","LABEL_NAME":"ADBRY 150 MG/ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50222035001","LABEL_NAME":"ADBRY 300 MG/2 ML AUTOINJECTOR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50242000701","LABEL_NAME":"ENSPRYNG 120 MG/ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50242004062","LABEL_NAME":"XOLAIR 150 MG/1.2 ML POWDER VL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50242007401","LABEL_NAME":"NUTROPIN AQ NUSPIN 10 INJECTOR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50242007501","LABEL_NAME":"NUTROPIN AQ NUSPIN 5 INJECTOR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50242007601","LABEL_NAME":"NUTROPIN AQ NUSPIN 20 INJECTOR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50242007908","LABEL_NAME":"ITOVEBI 9 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50242008408","LABEL_NAME":"ITOVEBI 3 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50242009002","LABEL_NAME":"ZELBORAF 240 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50242009130","LABEL_NAME":"ROZLYTREK 100 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50242009490","LABEL_NAME":"ROZLYTREK 200 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50242010039","LABEL_NAME":"PULMOZYME 1 MG/ML AMPUL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50242011501","LABEL_NAME":"PIASKY 340 MG/2 ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50242013001","LABEL_NAME":"ALECENSA 150 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50242013801","LABEL_NAME":"ACTEMRA 162 MG/0.9 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50242014001","LABEL_NAME":"ERIVEDGE 150 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50242014301","LABEL_NAME":"ACTEMRA ACTPEN 162 MG/0.9 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50242017505","LABEL_NAME":"EVRYSDI 60 MG/80 ML(0.75MG/ML)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50242020201","LABEL_NAME":"EVRYSDI 5 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50242021401","LABEL_NAME":"XOLAIR 75 MG/0.5 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50242021455","LABEL_NAME":"XOLAIR 75 MG/0.5 ML AUTOINJECT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50242021501","LABEL_NAME":"XOLAIR 150 MG/ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50242021555","LABEL_NAME":"XOLAIR 150 MG/ML AUTOINJECTOR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50242022701","LABEL_NAME":"XOLAIR 300 MG/2 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50242022755","LABEL_NAME":"XOLAIR 300 MG/2 ML AUTOINJECT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50242062301","LABEL_NAME":"ROZLYTREK 50 MG PELLET PACKET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50242071701","LABEL_NAME":"COTELLIC 20 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50242086001","LABEL_NAME":"XOFLUZA 40 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50242087701","LABEL_NAME":"XOFLUZA 80 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50268064711","LABEL_NAME":"ONDANSETRON 4 MG/5 ML SOLN CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50268064930","LABEL_NAME":"OXCARBAZEPINE 300 MG/5 ML CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50268085711","LABEL_NAME":"BALANCE B-50 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50268085715","LABEL_NAME":"BALANCE B-50 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50419017101","LABEL_NAME":"STIVARGA 40 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50419025001","LABEL_NAME":"ADEMPAS 0.5 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50419025101","LABEL_NAME":"ADEMPAS 1 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50419025201","LABEL_NAME":"ADEMPAS 1.5 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50419025301","LABEL_NAME":"ADEMPAS 2 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50419025401","LABEL_NAME":"ADEMPAS 2.5 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50419039001","LABEL_NAME":"VITRAKVI 25 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50419039101","LABEL_NAME":"VITRAKVI 100 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50419039201","LABEL_NAME":"VITRAKVI 20 MG/ML SOLUTION","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50419039501","LABEL_NAME":"NUBEQA 300 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50419039701","LABEL_NAME":"HYRNUO 10 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50419052401","LABEL_NAME":"BETASERON 0.3 MG KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50419054001","LABEL_NAME":"KERENDIA 10 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50419054101","LABEL_NAME":"KERENDIA 20 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50419054201","LABEL_NAME":"KERENDIA 40 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50419075001","LABEL_NAME":"LAMPIT 30 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50419075101","LABEL_NAME":"LAMPIT 120 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50428000280","LABEL_NAME":"CVS IBUPROFEN 200 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428000696","LABEL_NAME":"CVS ASPIRIN 81 MG CHEWABLE TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428002097","LABEL_NAME":"CVS INSECT REPELLENT 15% SPRAY","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428002662","LABEL_NAME":"CVS MICONAZOLE 3 COMBO PACK","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428002824","LABEL_NAME":"CVS IBUPROFEN 200 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428006205","LABEL_NAME":"CVS SALINE 0.65% NASAL SPRAY","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428009256","LABEL_NAME":"CVS GENTLE LAXATIVE EC 5 MG TB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428009980","LABEL_NAME":"CVS ATHLETE'S FOOT 1% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428010060","LABEL_NAME":"CVS JOCK ITCH 1% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428013831","LABEL_NAME":"CVS TUSSIN DM LIQUID","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428025036","LABEL_NAME":"CVS FOLIC ACID 800 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428025628","LABEL_NAME":"CVS CHILD CHEW VITAMN COMPLETE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428025901","LABEL_NAME":"CVS CORTISONE 1% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428025910","LABEL_NAME":"CVS IBUPROFEN JR STR 100 MG TB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428026854","LABEL_NAME":"CVS CHILD PAIN-FEVER 160 MG/5","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428026926","LABEL_NAME":"CVS GLYCERIN SUPPOSITORY","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428027137","LABEL_NAME":"CVS PRENATAL VITAMINS TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428027315","LABEL_NAME":"CVS ARTHRIT PAIN RLF ER 650 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428027709","LABEL_NAME":"CVS NICOTINE 2 MG LOZENGE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428027941","LABEL_NAME":"CVS TUSSIN 100 MG/5 ML LIQUID","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428028092","LABEL_NAME":"CVS ASPIRIN EC 81 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428028552","LABEL_NAME":"CVS ACETAMINOPHEN 500 MG GELCP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428028945","LABEL_NAME":"CVS VITAMIN B-6 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428029113","LABEL_NAME":"CVS NICOTINE 14 MG/24HR PATCH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428029733","LABEL_NAME":"CVS MAGNESIUM CITRATE SOLUTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428029821","LABEL_NAME":"CVS CHEST CONGESTION RLF TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428030074","LABEL_NAME":"CVS IBUPROFEN 200 MG SOFTGEL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428030208","LABEL_NAME":"CVS HYDROCORTISONE 1% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428030760","LABEL_NAME":"CVS PURELAX POWDER","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428030774","LABEL_NAME":"CVS IBUPROFEN 200 MG CAPLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428031575","LABEL_NAME":"CVS CHILD ALLERGY 12.5 MG/5 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428032024","LABEL_NAME":"CVS ALLERGY (DIPHEN) 25 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428032153","LABEL_NAME":"CVS TOTAL HOME INSECT 30% SPR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428032374","LABEL_NAME":"CVS NICOTINE 2 MG MINI LOZENGE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428032417","LABEL_NAME":"CVS NIGHTTIME SLEEP 25 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428032982","LABEL_NAME":"CVS 8HR ARTHRIT PAIN ER 650 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428033357","LABEL_NAME":"CVS ANTI-ITCH 1% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428033440","LABEL_NAME":"CVS NICOTINE 4 MG CHEWING GUM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428033528","LABEL_NAME":"CVS ANTI-FUNGAL 2% POWDER","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428033796","LABEL_NAME":"CVS NICOTINE 21 MG/24HR PATCH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428033841","LABEL_NAME":"CVS ACNE TREATMENT 10% GEL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428034503","LABEL_NAME":"CVS CHLD IBUPROFEN 100 MG/5 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428034940","LABEL_NAME":"CVS ATHLETE'S FOOT 2% PWD SPRY","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428035460","LABEL_NAME":"CVS SUPER B-COMPLEX-VIT C CPLT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428035731","LABEL_NAME":"CVS PAIN RELIEF 500 MG CAPLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428036338","LABEL_NAME":"CVS CHILD CHEST CONGEST-COUGH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428037702","LABEL_NAME":"CVS PURELAX POWDER","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428038300","LABEL_NAME":"CVS MICONAZOLE 7 CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428038612","LABEL_NAME":"CVS ACETAMINOPHEN 500 MG CPLT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428039470","LABEL_NAME":"CVS MICONAZOLE 3 COMBO PACK","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428039950","LABEL_NAME":"CVS PRENATAL MULTI-DHA SOFTGEL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428040297","LABEL_NAME":"CVS PAIN RELIEF 500 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428040525","LABEL_NAME":"CVS CHILD ALLERGY RELF 1 MG/ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428040647","LABEL_NAME":"CVS NICOTINE 4 MG MINI LOZENGE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428041363","LABEL_NAME":"CVS ACNE CONTROL 10 % CLEANSER","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428042108","LABEL_NAME":"CVS CORTISONE 1% GEL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428042738","LABEL_NAME":"CVS GLYCERIN 2 GM ADULT SUPPOS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428044257","LABEL_NAME":"CVS PRENATAL MULTIVIT-DHA SFGL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428044588","LABEL_NAME":"CVS INF IBUPROFEN 50 MG/1.25ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428045366","LABEL_NAME":"CVS FOAMING ACNE FACE 10% WASH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428047056","LABEL_NAME":"CVS CREAMY ACNE 4% FACE WASH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428047280","LABEL_NAME":"CVS ADV EXFOLIATING 5% CLEANSR","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428047392","LABEL_NAME":"CVS ALLERGY (DIPHEN) 25 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428047796","LABEL_NAME":"CVS SKIN TREATMENT BODY LOTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428052804","LABEL_NAME":"CVS BUDESONIDE 32 MCG SPRAY","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428053389","LABEL_NAME":"CVS NASAL ALLERGY 24HR SPRAY","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428055554","LABEL_NAME":"CVS ALLERGY (CETRZN) 10 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428057988","LABEL_NAME":"CVS CHILD PAIN RELIEF 160 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428063687","LABEL_NAME":"CVS MILK OF MAGNESIA SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428092378","LABEL_NAME":"CVS PAIN RELIEVER 500 MG CPLT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428166363","LABEL_NAME":"CVS BISACODYL EC 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50428207688","LABEL_NAME":"CVS CHILD PAIN RLF 160 MG/5 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50458002802","LABEL_NAME":"SPRAVATO 56 MG DOSE PACK","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50458002803","LABEL_NAME":"SPRAVATO 84 MG DOSE PACK","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50458056001","LABEL_NAME":"INVEGA SUSTENNA 39 MG/0.25 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50458056101","LABEL_NAME":"INVEGA SUSTENNA 78 MG/0.5 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50458056201","LABEL_NAME":"INVEGA SUSTENNA 117 MG/0.75 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50458056301","LABEL_NAME":"INVEGA SUSTENNA 156 MG/ML SYRG","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50458056401","LABEL_NAME":"INVEGA SUSTENNA 234 MG/1.5 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50458057501","LABEL_NAME":"XARELTO 1 MG/ML SUSPENSION","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50458057701","LABEL_NAME":"XARELTO 2.5 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50458057801","LABEL_NAME":"XARELTO 15 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50458057901","LABEL_NAME":"XARELTO 20 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50458058001","LABEL_NAME":"XARELTO 10 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50458058451","LABEL_NAME":"XARELTO DVT-PE TREAT START 30D","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50458060601","LABEL_NAME":"INVEGA TRINZA 273 MG/0.88 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50458060701","LABEL_NAME":"INVEGA TRINZA 410 MG/1.32 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50458060801","LABEL_NAME":"INVEGA TRINZA 546 MG/1.75 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50458060901","LABEL_NAME":"INVEGA TRINZA 819 MG/2.63 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50474037066","LABEL_NAME":"BRIVIACT 10 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50474047009","LABEL_NAME":"BRIVIACT 25 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50474050014","LABEL_NAME":"NAYZILAM 5 MG NASAL SPRAY","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50474057009","LABEL_NAME":"BRIVIACT 50 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50474067066","LABEL_NAME":"BRIVIACT 75 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50474070062","LABEL_NAME":"CIMZIA 2X200 MG VIAL KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50474071079","LABEL_NAME":"CIMZIA 2X200 MG/ML SYRINGE KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50474071081","LABEL_NAME":"CIMZIA 2X200 MG/ML(X3)START KT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50474075010","LABEL_NAME":"CIMZIA 200 MG/ML SYRINGE KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50474077009","LABEL_NAME":"BRIVIACT 100 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50474087015","LABEL_NAME":"BRIVIACT 10 MG/ML ORAL SOLN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50474099080","LABEL_NAME":"ZILBRYSQ 16.6 MG/0.416 ML SYRN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50474099180","LABEL_NAME":"ZILBRYSQ 23 MG/0.574 ML SYRING","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50474099280","LABEL_NAME":"ZILBRYSQ 32.4 MG/0.81 ML SYRNG","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50484001030","LABEL_NAME":"SANTYL OINTMENT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50632000101","LABEL_NAME":"JYNNEOS 0.5 ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50632000102","LABEL_NAME":"JYNNEOS 0.5 ML VIAL(STOCKPILE)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50632000701","LABEL_NAME":"PRO COMFORT 30G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50632000702","LABEL_NAME":"PRO COMFORT 1 ML 30GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50632000705","LABEL_NAME":"PRO COMFORT 1 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50632000706","LABEL_NAME":"PRO COMFORT 0.5 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50632000707","LABEL_NAME":"PRO COMFORT 0.5 ML 30GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50632000708","LABEL_NAME":"PRO COMFORT 0.5 ML 30GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50632000709","LABEL_NAME":"PRO COMFORT 1 ML 30GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50632000712","LABEL_NAME":"PRO COMFORT 31G LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50632000716","LABEL_NAME":"SAPS TWIST TOP 30G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50632000727","LABEL_NAME":"PRO COMFORT SPACER-ADULT MASK","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50632000728","LABEL_NAME":"PRO COMFORT SPACER-CHILD MASK","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50632000731","LABEL_NAME":"EASY COMFORT 30G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50632000740","LABEL_NAME":"EASY COMFORT 0.5 ML 32GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50632000741","LABEL_NAME":"EASY COMFORT 1 ML 32GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50632000756","LABEL_NAME":"PRO COMFORT SPACER-INFANT MASK","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50632000773","LABEL_NAME":"INSULIN SYRIN 0.5 ML 30G 1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50632000774","LABEL_NAME":"INSULIN SYRINGE 1 ML 30G 5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50632000776","LABEL_NAME":"TWIST TOP 30G LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50632000786","LABEL_NAME":"SWI TWIST TOP 30G LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50633022004","LABEL_NAME":"VISTOGARD 10 GRAM PACKET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50633033002","LABEL_NAME":"XURIDEN 2 GM GRANULE PACKET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50716000524","LABEL_NAME":"SAWYER CONTROL RELEASE 20% LOT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50716000544","LABEL_NAME":"INSECT REPELLENT 20% SPRAY","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50716000711","LABEL_NAME":"MAXI-DEET 98.11% SPRAY","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50742019105","LABEL_NAME":"PRIMAQUINE 26.3 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50742025601","LABEL_NAME":"CARISOPRODOL-ASPIRIN-CODEIN TB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50742029909","LABEL_NAME":"FROVATRIPTAN SUCC 2.5 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50742035401","LABEL_NAME":"MESNA 400 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50742038701","LABEL_NAME":"CONJUGATED ESTROGENS 0.3 MG TB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50742038801","LABEL_NAME":"CONJUGATED ESTROGENS 0.45MG TB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50742038901","LABEL_NAME":"CONJUGATED ESTROGEN 0.625MG TB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50742039001","LABEL_NAME":"CONJUGATED ESTROGENS 0.9 MG TB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50742039101","LABEL_NAME":"CONJUGATED ESTROGENS 1.25MG TB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50742062001","LABEL_NAME":"NIFEDIPINE ER 30 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50742062101","LABEL_NAME":"NIFEDIPINE ER 60 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50742062201","LABEL_NAME":"NIFEDIPINE ER 90 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50742065828","LABEL_NAME":"ESTRADIOL-NORETH 0.5-0.1 MG TB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50742065928","LABEL_NAME":"DOLISHALE 90-20 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50804009108","LABEL_NAME":"GS ALLERGY (DIPHEN) 25 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50804032756","LABEL_NAME":"GS BISACODYL EC 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50804037130","LABEL_NAME":"GS MUCUS RELIEF 400 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50804064712","LABEL_NAME":"GS MILK OF MAGNESIA SUSPENSION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50804082603","LABEL_NAME":"GS PAIN RELIEF 500 MG GELCAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50804088004","LABEL_NAME":"GS ASPIRIN EC 81 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50881000560","LABEL_NAME":"JAKAFI 5 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50881000705","LABEL_NAME":"OPZELURA 1.5% CREAM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50881001060","LABEL_NAME":"JAKAFI 10 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50881001560","LABEL_NAME":"JAKAFI 15 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50881002060","LABEL_NAME":"JAKAFI 20 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50881002560","LABEL_NAME":"JAKAFI 25 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50881002601","LABEL_NAME":"PEMAZYRE 4.5 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50881002701","LABEL_NAME":"PEMAZYRE 9 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50881002801","LABEL_NAME":"PEMAZYRE 13.5 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"50924004301","LABEL_NAME":"COAGUCHEK LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50924007920","LABEL_NAME":"ACCU-CHEK SAFE-T-PRO PLUS 23G","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50924010910","LABEL_NAME":"CHEMSTRIP-9","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50924014510","LABEL_NAME":"CHEMSTRIP 10 WITH SG","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50924021807","LABEL_NAME":"CHEMSTRIP 7","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50924046706","LABEL_NAME":"CHEMSTRIP 50B","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50924074310","LABEL_NAME":"CHEMSTRIP 2 GP","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50924082810","LABEL_NAME":"CHEMSTRIP 10 MD","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50924095120","LABEL_NAME":"ACCU-CHEK SAFE-T-PRO 23G LANCT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"50924097110","LABEL_NAME":"ACCU-CHEK SOFTCLIX LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"51028000102","LABEL_NAME":"MEDLANCE PLUS 21G LANCETS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"51028000103","LABEL_NAME":"MEDLANCE PLUS LITE 25G LANCETS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"51028000133","LABEL_NAME":"MEDLANCE PLUS 30G LANCETS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"51079002001","LABEL_NAME":"BUDESONIDE EC 3 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51131067442","LABEL_NAME":"ULTRATHON 34.34% REPEL LOTION","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"51131067777","LABEL_NAME":"ULTRATHON 25% REPELLENT SPRAY","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"51144000160","LABEL_NAME":"TUKYSA 50 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51144000212","LABEL_NAME":"TUKYSA 150 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51167010602","LABEL_NAME":"TRIKAFTA 50-25-37.5 MG/75 MG","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51167011301","LABEL_NAME":"SYMDEKO 50/75 MG-75 MG TABLETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51167012101","LABEL_NAME":"ALYFTREK 10-50-125 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51167012201","LABEL_NAME":"ORKAMBI 75-94 MG GRANULE PKT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51167013501","LABEL_NAME":"ALYFTREK 4-20-50 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51167020001","LABEL_NAME":"KALYDECO 150 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51167030001","LABEL_NAME":"KALYDECO 50 MG GRANULES PACKET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51167033101","LABEL_NAME":"TRIKAFTA 100-50-75 MG/150 MG","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51167040001","LABEL_NAME":"KALYDECO 75 MG GRANULES PACKET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51167044501","LABEL_NAME":"TRIKAFTA 80-40-60MG/59.5MG PKT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51167044601","LABEL_NAME":"TRIKAFTA 100-50-75 MG/75MG PKT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51167050002","LABEL_NAME":"ORKAMBI 150-188 MG GRANULE PKT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51167060001","LABEL_NAME":"KALYDECO 25 MG GRANULES PACKET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51167066101","LABEL_NAME":"SYMDEKO 100/150 MG-150 MG TABS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51167070002","LABEL_NAME":"ORKAMBI 100 MG-125 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51167077001","LABEL_NAME":"KALYDECO 13.4 MG GRANULES PKT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51167078501","LABEL_NAME":"KALYDECO 5.8 MG GRANULES PKT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51167080901","LABEL_NAME":"ORKAMBI 200 MG-125 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51167090001","LABEL_NAME":"ORKAMBI 100-125 MG GRANULE PKT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51407070701","LABEL_NAME":"RAMIPRIL 2.5 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51407070801","LABEL_NAME":"RAMIPRIL 5 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51407070901","LABEL_NAME":"RAMIPRIL 10 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51525023403","LABEL_NAME":"AZELASTINE 0.15% NASAL SPRAY","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51660099530","LABEL_NAME":"COLESEVELAM HCL 3.75 G PACKET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51672129701","LABEL_NAME":"CLOBETASOL EMOLLIENT 0.05% CRM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51672131601","LABEL_NAME":"ALCLOMETASONE DIPR 0.05% OINT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51672136203","LABEL_NAME":"NAFTIFINE HCL 1% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51672136803","LABEL_NAME":"NAFTIFINE HCL 2% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51672137104","LABEL_NAME":"CLOBETASOL PROP 0.05% SPRAY","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51672200306","LABEL_NAME":"CLOTRIMAZOLE 1% VAGINAL CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"51672203506","LABEL_NAME":"MICONAZOLE 2% VAGINAL CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"51672206200","LABEL_NAME":"3-DAY VAGINAL CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"51672207308","LABEL_NAME":"LORATADINE 5 MG/5 ML SYRUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"51672210403","LABEL_NAME":"INSTALAX POWDER","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"51672211400","LABEL_NAME":"FEVERALL 80 MG SUPPOSITORY","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"51672211502","LABEL_NAME":"FEVERALL 120 MG SUPPOSITORY","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"51672211602","LABEL_NAME":"FEVERALL 325 MG SUPPOSITORY","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"51672211704","LABEL_NAME":"FEVERALL 650 MG SUPPOSITORY","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"51672401601","LABEL_NAME":"ETODOLAC 200 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51672401701","LABEL_NAME":"ETODOLAC 300 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51672404501","LABEL_NAME":"ENALAPRIL-HCTZ 5-12.5 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51672404704","LABEL_NAME":"CARBAMAZEPINE 100 MG/5 ML SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51672405506","LABEL_NAME":"AMIODARONE HCL 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51672405706","LABEL_NAME":"AMIODARONE HCL 400 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51672406102","LABEL_NAME":"HYDROCORTISONE BUTYR 0.1% SOLN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51672406201","LABEL_NAME":"FLUOROURACIL 2% TOPICAL SOLN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51672406902","LABEL_NAME":"PHENYTOIN 125 MG/5 ML SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51672407401","LABEL_NAME":"HYDROCORTISONE BUTY 0.1% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51672407904","LABEL_NAME":"DESONIDE 0.05% LOTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51672408301","LABEL_NAME":"HYDROCORTISONE BUTYR 0.1% OINT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51672415101","LABEL_NAME":"CARBAMAZEPINE ER 100 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51672415403","LABEL_NAME":"CALCIPOTRIENE 0.005% OINTMENT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51672416409","LABEL_NAME":"METRONIDAZOLE TOP 1% GEL PUMP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51672529404","LABEL_NAME":"MALATHION 0.5% LOTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51709000605","LABEL_NAME":"AIMSCO LATEX CONDOM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"51759020210","LABEL_NAME":"AJOVY 225 MG/1.5 ML AUTOINJECT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51759020222","LABEL_NAME":"AJOVY 225MG/1.5ML AUTOINJ (X3)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51759020410","LABEL_NAME":"AJOVY 225 MG/1.5 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51759027417","LABEL_NAME":"SIMLANDI(CF) AI 80 MG/0.8 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51759030510","LABEL_NAME":"UZEDY ER 50 MG/0.14 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51759038622","LABEL_NAME":"SIMLANDI(CF) 20 MG/0.2 ML SYRG","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51759040202","LABEL_NAME":"SIMLANDI(CF) AI 40 MG/0.4 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51759041010","LABEL_NAME":"UZEDY ER 75 MG/0.21 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51759041222","LABEL_NAME":"SIMLANDI(CF) 40 MG/0.4 ML SYRG","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51759050513","LABEL_NAME":"SELARSDI 45 MG/0.5 ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51759050532","LABEL_NAME":"SELARSDI 45 MG/0.5 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51759052010","LABEL_NAME":"UZEDY ER 100 MG/0.28 ML SYRING","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51759060732","LABEL_NAME":"SELARSDI 90 MG/ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51759063010","LABEL_NAME":"UZEDY ER 125 MG/0.35 ML SYRING","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51759074010","LABEL_NAME":"UZEDY ER 150 MG/0.42 ML SYRING","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51759085010","LABEL_NAME":"UZEDY ER 200 MG/0.56 ML SYRING","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51759096010","LABEL_NAME":"UZEDY ER 250 MG/0.7 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51801000130","LABEL_NAME":"EFFER-K 25 MEQ TABLET EFF","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51824004901","LABEL_NAME":"NON-ASPIRIN 500 MG CAPLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"51862002801","LABEL_NAME":"LUTERA-28 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51862003601","LABEL_NAME":"ZARAH TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51862004701","LABEL_NAME":"AMETHIA 0.15-0.03-0.01 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51862023801","LABEL_NAME":"CAZIANT 28 DAY TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51862056401","LABEL_NAME":"LOW-OGESTREL-28 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51862068201","LABEL_NAME":"SOLTAMOX 20 MG/10 ML SOLN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51862088401","LABEL_NAME":"CAMILA 0.35 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51862088601","LABEL_NAME":"ERRIN 0.35 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51991007401","LABEL_NAME":"ASCOMP WITH CODEINE CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51991019101","LABEL_NAME":"METHSCOPOLAMINE BROM 2.5 MG TB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51991019206","LABEL_NAME":"METHSCOPOLAMINE BROM 5 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51991073520","LABEL_NAME":"GRANISETRON HCL 1 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"51991092860","LABEL_NAME":"ASENAPINE 2.5 MG TABLET SL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"52015070022","LABEL_NAME":"DIFICID 40 MG/ML SUSPENSION","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"52246057004","LABEL_NAME":"SPINOSAD 0.9% TOPICAL SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"52343004401","LABEL_NAME":"ZIDOVUDINE 100 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"52376002102","LABEL_NAME":"PAROEX 0.12% ORAL RINSE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"52536013013","LABEL_NAME":"ERYTHROMYCIN 400 MG/5 ML SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"52536013213","LABEL_NAME":"ERYTHROMYCIN 200 MG/5 ML SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"52536088001","LABEL_NAME":"VERAPAMIL SR 120 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"52536088201","LABEL_NAME":"VERAPAMIL SR 180 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"52536088401","LABEL_NAME":"VERAPAMIL SR 240 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"52544069119","LABEL_NAME":"MATZIM LA 180 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"52544069219","LABEL_NAME":"MATZIM LA 240 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"52544069319","LABEL_NAME":"MATZIM LA 300 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"52544069419","LABEL_NAME":"MATZIM LA 360 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"52709150101","LABEL_NAME":"GRASTEK 2,800 BAU SL TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"52709160101","LABEL_NAME":"RAGWITEK SUBLINGUAL TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"52709170101","LABEL_NAME":"ODACTRA 12 SQ-HDM SL TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"52817072001","LABEL_NAME":"APOMORPHINE 30 MG/3 ML CARTRDG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"52817081615","LABEL_NAME":"ACETIC ACID 2% EAR SOLUTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"52817083004","LABEL_NAME":"LEVOCARNITINE 1 G/10 ML SOLN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"52856020101","LABEL_NAME":"SEPHIENCE 250 MG POWDER PACKET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"52856030101","LABEL_NAME":"SEPHIENCE 1,000 MG POWDER PKT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"52982000600","LABEL_NAME":"ADVOCATE LANCING DEVICE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"53062001202","LABEL_NAME":"BETA HC 1% LOTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"53062002704","LABEL_NAME":"BETATEMP 160 MG/5 ML SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"53329007964","LABEL_NAME":"CARRINGTON ANTIFUNGAL 2% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"53329008057","LABEL_NAME":"INZO ANTIFUNGAL 2% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"53329016204","LABEL_NAME":"REMEDY ANTIFUNGAL 2% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"53329016979","LABEL_NAME":"REMEDY PHYTOPLEX ANTIFUNGAL 2%","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"53436001001","LABEL_NAME":"VELTASSA 1 GM POWDER PACKET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"53436008401","LABEL_NAME":"VELTASSA 8.4 GM POWDER PACKET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"53436016801","LABEL_NAME":"VELTASSA 16.8 GM POWDER PACKET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"53459000073","LABEL_NAME":"EZ SMART 28G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"53489014501","LABEL_NAME":"SULFAMETHOXAZOLE-TMP SS TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"53489014601","LABEL_NAME":"SULFAMETHOXAZOLE-TMP DS TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"53489017601","LABEL_NAME":"ALBUTEROL SULFATE 2 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"53489017701","LABEL_NAME":"ALBUTEROL SULFATE 4 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"53489028101","LABEL_NAME":"ERGOLOID MESYLATES 1 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"53489055101","LABEL_NAME":"PROPAFENONE HCL 150 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"53489055201","LABEL_NAME":"PROPAFENONE HCL 225 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"53489055301","LABEL_NAME":"PROPAFENONE HCL 300 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"53746011701","LABEL_NAME":"HYDROCODONE-IBUPROFEN 10-200","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"53746014601","LABEL_NAME":"HYDROCODONE-IBUPROFEN 5-200 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"53746024930","LABEL_NAME":"ALOSETRON HCL 1 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"53746061701","LABEL_NAME":"TRAMADOL-ACETAMINOPHN 37.5-325","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"53746074501","LABEL_NAME":"PROMETHAZINE 12.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"53885027810","LABEL_NAME":"ONETOUCH ULTRASOFT2 30G LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"53885031820","LABEL_NAME":"ONETOUCH DELICA SAF 30G LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"54092018981","LABEL_NAME":"PENTASA 250 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"54257057303","LABEL_NAME":"ACETAMINOPHEN ER 650 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"54288014001","LABEL_NAME":"LEVOFLOXACIN 1.5% EYE DROPS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"54482002002","LABEL_NAME":"CYSTARAN 0.44% EYE DROPS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"54482005401","LABEL_NAME":"MATULANE 50 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"54629005201","LABEL_NAME":"PRENATAL MULTIVITAMIN TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"54629012691","LABEL_NAME":"FULL SPECTRUM B WITH VIT C TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"54629056301","LABEL_NAME":"B COMPLEX NUMBER 1 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"54629059606","LABEL_NAME":"STRESS FORMULA WITH IRON TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"54746000101","LABEL_NAME":"ALFERON N 5 MILLION UNITS VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"54838000650","LABEL_NAME":"VITAMIN D3 10 MCG/ML LIQUID","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"54838051080","LABEL_NAME":"OXYBUTYNIN 5 MG/5 ML SYRUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"54838051240","LABEL_NAME":"DOXEPIN 10 MG/ML ORAL CONC","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"54859051016","LABEL_NAME":"TUSSIN 100 MG/5 ML LIQUID","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"54859080916","LABEL_NAME":"ACETAMINOPHEN 160 MG/5 ML LIQ","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"55111011379","LABEL_NAME":"ZENATANE 30 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55111013579","LABEL_NAME":"ZENATANE 10 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55111013679","LABEL_NAME":"ZENATANE 20 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55111013779","LABEL_NAME":"ZENATANE 40 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55111017001","LABEL_NAME":"OXAPROZIN 600 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55111033901","LABEL_NAME":"AMLODIPINE-BENAZEPRIL 5-10 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55111034101","LABEL_NAME":"AMLODIPINE-BENAZEPRIL 10-20 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55111043890","LABEL_NAME":"RAMIPRIL 1.25 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55111058701","LABEL_NAME":"AMLODIPINE-BENAZEPRIL 5-40 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55111068201","LABEL_NAME":"IBU 400 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55111068301","LABEL_NAME":"IBU 600 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55111068401","LABEL_NAME":"IBU 800 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55292013160","LABEL_NAME":"SIGNIFOR 0.3 MG/ML AMPULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55292013260","LABEL_NAME":"SIGNIFOR 0.6 MG/ML AMPULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55292013360","LABEL_NAME":"SIGNIFOR 0.9 MG/ML AMPULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55292013901","LABEL_NAME":"SIGNIFOR LAR 10 MG KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55292014001","LABEL_NAME":"SIGNIFOR LAR 20 MG KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55292014101","LABEL_NAME":"SIGNIFOR LAR 30 MG KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55292014201","LABEL_NAME":"SIGNIFOR LAR 40 MG KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55292014301","LABEL_NAME":"SIGNIFOR LAR 60 MG KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55292020111","LABEL_NAME":"CHEMET 100 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55292032020","LABEL_NAME":"ISTURISA 1 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55292032120","LABEL_NAME":"ISTURISA 5 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55292041005","LABEL_NAME":"CYSTADROPS 0.37% EYE DROPS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55466010411","LABEL_NAME":"LEVO-T 25 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55466010511","LABEL_NAME":"LEVO-T 50 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55466010611","LABEL_NAME":"LEVO-T 75 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55466010711","LABEL_NAME":"LEVO-T 88 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55466010811","LABEL_NAME":"LEVO-T 100 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55466010911","LABEL_NAME":"LEVO-T 112 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55466011011","LABEL_NAME":"LEVO-T 125 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55466011111","LABEL_NAME":"LEVO-T 137 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55466011211","LABEL_NAME":"LEVO-T 150 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55466011311","LABEL_NAME":"LEVO-T 175 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55466011411","LABEL_NAME":"LEVO-T 200 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55466011511","LABEL_NAME":"LEVO-T 300 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55513000201","LABEL_NAME":"ARANESP 25 MCG/ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55513000301","LABEL_NAME":"ARANESP 40 MCG/ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55513000401","LABEL_NAME":"ARANESP 60 MCG/ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55513000501","LABEL_NAME":"ARANESP 100 MCG/ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55513000601","LABEL_NAME":"ARANESP 200 MCG/ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55513002101","LABEL_NAME":"ARANESP 40 MCG/0.4 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55513002301","LABEL_NAME":"ARANESP 60 MCG/0.3 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55513002501","LABEL_NAME":"ARANESP 100 MCG/0.5 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55513002701","LABEL_NAME":"ARANESP 150 MCG/0.3 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55513002801","LABEL_NAME":"ARANESP 200 MCG/0.4 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55513003201","LABEL_NAME":"ARANESP 500 MCG/1 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55513005701","LABEL_NAME":"ARANESP 25 MCG/0.42 ML SYRING","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55513009801","LABEL_NAME":"ARANESP 10 MCG/0.4 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55513011101","LABEL_NAME":"ARANESP 300 MCG/0.6 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55513011201","LABEL_NAME":"TEZSPIRE 210 MG/1.91 ML SYRING","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55513012301","LABEL_NAME":"TEZSPIRE 210 MG/1.91 ML PEN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55513012601","LABEL_NAME":"EPOGEN 2,000 UNITS/ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55513013760","LABEL_NAME":"OTEZLA 30 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55513014401","LABEL_NAME":"EPOGEN 10,000 UNITS/ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55513014801","LABEL_NAME":"EPOGEN 4,000 UNITS/ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55513019001","LABEL_NAME":"NEULASTA 6 MG/0.6 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55513019201","LABEL_NAME":"NEULASTA ONPRO 6 MG/0.6 ML KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55513020901","LABEL_NAME":"NEUPOGEN 480 MCG/0.8 ML SYR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55513026701","LABEL_NAME":"EPOGEN 3,000 UNITS/ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55513028301","LABEL_NAME":"EPOGEN 20,000 UNIT/2 ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55513036955","LABEL_NAME":"OTEZLA 10-20-30MG START 28 DAY","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55513047801","LABEL_NAME":"EPOGEN 20,000 UNITS/ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55513048824","LABEL_NAME":"LUMAKRAS 120 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55513049760","LABEL_NAME":"OTEZLA 20 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55513050450","LABEL_NAME":"LUMAKRAS 320 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55513050855","LABEL_NAME":"OTEZLA 10-20 MG STARTER 28 DAY","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55513051260","LABEL_NAME":"LUMAKRAS 240 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55513051641","LABEL_NAME":"OTEZLA XR INITIATION PK 28 DAY","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55513051930","LABEL_NAME":"OTEZLA XR 75 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55513053001","LABEL_NAME":"NEUPOGEN 300 MCG/ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55513054601","LABEL_NAME":"NEUPOGEN 480 MCG/1.6 ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55513084101","LABEL_NAME":"AIMOVIG 70 MG/ML AUTOINJECTOR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55513084301","LABEL_NAME":"AIMOVIG 140 MG/ML AUTOINJECTOR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55513092401","LABEL_NAME":"NEUPOGEN 300 MCG/0.5 ML SYR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55566150201","LABEL_NAME":"NOVAREL 5,000 UNIT VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55566180101","LABEL_NAME":"ZOMACTON 5 MG VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55566190101","LABEL_NAME":"ZOMACTON 10 MG VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55566830301","LABEL_NAME":"FIRMAGON 80 MG KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55566840301","LABEL_NAME":"FIRMAGON 2 X 120 MG KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"55724021111","LABEL_NAME":"EUCRISA 2% OINTMENT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"56151014201","LABEL_NAME":"TRUEDRAW LANCING DEVICE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"56151014701","LABEL_NAME":"TRUEPLUS 33G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"56151024221","LABEL_NAME":"THIN LANCETS 28G","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"56184010653","LABEL_NAME":"LITTLE REMEDIES FEVER 160 MG/5","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"57237000101","LABEL_NAME":"LANSOPRAZOL-AMOXICIL-CLARITHRO","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"57237001106","LABEL_NAME":"MIRTAZAPINE 15 MG ODT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"57237001206","LABEL_NAME":"MIRTAZAPINE 30 MG ODT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"57237001306","LABEL_NAME":"MIRTAZAPINE 45 MG ODT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"57237008901","LABEL_NAME":"TRANDOLAPRIL 1 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"57237009001","LABEL_NAME":"TRANDOLAPRIL 2 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"57237009101","LABEL_NAME":"TRANDOLAPRIL 4 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"57237030412","LABEL_NAME":"ACETAMINOPHEN 160 MG/5 ML SOLN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"57237030512","LABEL_NAME":"DIPHENHYDRAMINE 12.5 MG/5 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"57237032072","LABEL_NAME":"NICOTINE 2 MG MINI LOZENGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"57237032172","LABEL_NAME":"NICOTINE 4 MG MINI LOZENGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"57237036701","LABEL_NAME":"DIMETANE 25 MG SOFTGEL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"57513000649","LABEL_NAME":"INSULIN SYRIN 0.3 ML 30GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"57515003259","LABEL_NAME":"ULTICARE SAFETY 0.5 ML 29GX1/2","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"57515018218","LABEL_NAME":"INSULIN SYRINGE 1 ML 28GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"57515018258","LABEL_NAME":"INSULIN SYRIN 0.5 ML 28GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"57515019219","LABEL_NAME":"INSULIN SYRINGE 1 ML 29GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"57515019259","LABEL_NAME":"INSULIN SYRIN 0.5 ML 29GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"57515019315","LABEL_NAME":"INSULIN SYRINGE 1 ML 30GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"57515019335","LABEL_NAME":"INSULIN SYRIN 0.3 ML 30GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"57515019355","LABEL_NAME":"INSULIN SYRIN 0.5 ML 30GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"57515095010","LABEL_NAME":"INSULIN SYRINGE 0.3 ML 31GX1/4","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"57515095011","LABEL_NAME":"INSULIN SYR 0.3ML 31GX1/4(1/2)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"57515095012","LABEL_NAME":"INSULIN SYRINGE 0.5 ML 31GX1/4","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"57515095013","LABEL_NAME":"INSULIN SYRINGE 1 ML 31GX1/4\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"57599000101","LABEL_NAME":"FREESTYLE LIBRE 14 DAY SENSOR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":true,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"57599000200","LABEL_NAME":"FREESTYLE LIBRE 14 DAY READER","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":true,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"57599004305","LABEL_NAME":"MEDISENSE THIN 28G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"57599080000","LABEL_NAME":"FREESTYLE LIBRE 2 SENSOR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":true,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"57599080300","LABEL_NAME":"FREESTYLE LIBRE 2 READER","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":true,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"57599081800","LABEL_NAME":"FREESTYLE LIBRE 3 SENSOR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":true,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"57599082000","LABEL_NAME":"FREESTYLE LIBRE 3 READER","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":true,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"57599083500","LABEL_NAME":"FREESTYLE LIBRE 2 PLUS SENSOR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":true,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"57599084400","LABEL_NAME":"FREESTYLE LIBRE 3 PLUS SENSOR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":true,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"57599084401","LABEL_NAME":"FREESTYLE LIBRE 3 PLUS SENSOR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"57599157701","LABEL_NAME":"FREESTYLE PREC NEO TEST STRIPS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"57599868105","LABEL_NAME":"MEDISENSE THIN LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"57599874605","LABEL_NAME":"UNISTIK 2 NORMAL 21G LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"57599881401","LABEL_NAME":"PRECISION XTRA MONITOR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"57629000412","LABEL_NAME":"GENTEEL VACUUM LANCING DEVICE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"57629000420","LABEL_NAME":"BUTTERFLY TOUCH 30-36G LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"57629020310","LABEL_NAME":"HYOSCYAMINE SR 0.375 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"57664011688","LABEL_NAME":"VERAPAMIL ER 120 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"57664011713","LABEL_NAME":"VERAPAMIL ER 180 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"57664011813","LABEL_NAME":"VERAPAMIL ER 240 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"57664043718","LABEL_NAME":"DIGOXIN 0.125 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"57664044118","LABEL_NAME":"DIGOXIN 0.25 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"57664068488","LABEL_NAME":"MIGLITOL 25 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"57664068688","LABEL_NAME":"MIGLITOL 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"57894005060","LABEL_NAME":"AKEEGA 50-500 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"57894007001","LABEL_NAME":"SIMPONI 50 MG/0.5 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"57894007002","LABEL_NAME":"SIMPONI 50 MG/0.5 ML PEN INJEC","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"57894007101","LABEL_NAME":"SIMPONI 100 MG/ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"57894007102","LABEL_NAME":"SIMPONI 100 MG/ML PEN INJECTOR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"57894008060","LABEL_NAME":"LAZCLUZE 80 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"57894010060","LABEL_NAME":"AKEEGA 100-500 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"57894024030","LABEL_NAME":"LAZCLUZE 240 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"57894064001","LABEL_NAME":"TREMFYA 100 MG/ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"57894064006","LABEL_NAME":"TREMFYA 100 MG/ML PEN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"57894064011","LABEL_NAME":"TREMFYA 100 MG/ML ONE-PRESS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"57894065102","LABEL_NAME":"TREMFYA 200 MG/2 ML PEN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"57894065104","LABEL_NAME":"TREMFYA INDCT 200MG/2ML X2 PEN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"57894065122","LABEL_NAME":"TREMFYA 200 MG/2 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"57896014803","LABEL_NAME":"CHILD ACETAMINOPHEN 80 MG CHEW","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"57896016016","LABEL_NAME":"PAIN RELIEF 160 MG/5 ML LIQUID","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"57896020608","LABEL_NAME":"PAIN RELIEF ADULT 500 MG/15 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"57896029316","LABEL_NAME":"GERI-TUSSIN 200 MG/10 ML LIQ","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"57896040101","LABEL_NAME":"DOCUSATE SODIUM 100 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"57896057501","LABEL_NAME":"PRENATAL TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"57896061512","LABEL_NAME":"GENTLE LAXATIVE 1,200 MG/15 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"57896069304","LABEL_NAME":"GERI-TUSSIN 100 MG/5 ML SOLN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"57896071401","LABEL_NAME":"MUCUS RELIEF 400 MG CAPLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"57896098016","LABEL_NAME":"GERI-DRYL 12.5 MG/5 ML LIQUID","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"57962000712","LABEL_NAME":"IMBRUVICA 70 MG/ML SUSPENSION","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"57962001428","LABEL_NAME":"IMBRUVICA 140 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"57962007028","LABEL_NAME":"IMBRUVICA 70 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"57962014009","LABEL_NAME":"IMBRUVICA 140 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"57962028028","LABEL_NAME":"IMBRUVICA 280 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"57962042028","LABEL_NAME":"IMBRUVICA 420 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"57963010304","LABEL_NAME":"G TUSSIN AC LIQUID","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"58151011801","LABEL_NAME":"DILANTIN 30 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"58154010001","LABEL_NAME":"SHAKE THAT ACHE 500 MG CAPLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"58160072615","LABEL_NAME":"HIBERIX VIAL AND DILUENT SYRG","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"58160075715","LABEL_NAME":"PENMENVY MEN A-B-C-W-Y KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"58160081043","LABEL_NAME":"INFANRIX DTAP SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"58160081143","LABEL_NAME":"PEDIARIX 0.5 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"58160081243","LABEL_NAME":"KINRIX TIP-LOK SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"58160081912","LABEL_NAME":"SHINGRIX VIAL KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"58160082043","LABEL_NAME":"ENGERIX-B PEDI 10 MCG/0.5 SYRN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"58160082101","LABEL_NAME":"ENGERIX-B 20 MCG/ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"58160082143","LABEL_NAME":"ENGERIX-B 20 MCG/ML SYRN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"58160082415","LABEL_NAME":"PRIORIX VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"58160082543","LABEL_NAME":"HAVRIX 720 UNIT/0.5 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"58160082643","LABEL_NAME":"HAVRIX 1,440 UNIT/ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"58160082703","LABEL_NAME":"MENVEO 1 VIAL-A-C-Y-W-135-DIP","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"58160084243","LABEL_NAME":"BOOSTRIX TDAP VACCINE SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"58160084811","LABEL_NAME":"AREXVY VIAL KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"58160084943","LABEL_NAME":"SHINGRIX 50 MCG/0.5 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"58160091241","LABEL_NAME":"FLUARIX 2025-2026 SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"58160095509","LABEL_NAME":"MENVEO A-C-Y-W  KIT (2 VIALS)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"58160097602","LABEL_NAME":"BEXSERO PREFILLED SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"58284020801","LABEL_NAME":"BRIXADI WEEKLY 8 MG/0.16ML SYR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"58284021601","LABEL_NAME":"BRIXADI WEEKLY 16MG/0.32ML SYR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"58284022401","LABEL_NAME":"BRIXADI WEEKLY 24MG/0.48ML SYR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"58284022801","LABEL_NAME":"BRIXADI MONTH 128MG/0.36ML SYR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"58284023201","LABEL_NAME":"BRIXADI WEEKLY 32MG/0.64ML SYR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"58284026401","LABEL_NAME":"BRIXADI MONTH 64 MG/0.18ML SYR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"58284029601","LABEL_NAME":"BRIXADI MONTH 96 MG/0.27ML SYR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"58406001001","LABEL_NAME":"ENBREL 25 MG/0.5 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"58406002101","LABEL_NAME":"ENBREL 50 MG/ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"58406003201","LABEL_NAME":"ENBREL 50 MG/ML SURECLICK","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"58406004401","LABEL_NAME":"ENBREL 50 MG/ML MINI CARTRIDGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"58406005501","LABEL_NAME":"ENBREL 25 MG/0.5 ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"58468022001","LABEL_NAME":"CERDELGA 84 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"58468022501","LABEL_NAME":"CABLIVI 11 MG KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"58468025106","LABEL_NAME":"WAYRILZ 400 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"58468034701","LABEL_NAME":"QFITLIA 20 MG/0.2 ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"58468034801","LABEL_NAME":"QFITLIA 50 MG/0.5 ML PEN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"58468782003","LABEL_NAME":"CAPRELSA 100 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"58468784003","LABEL_NAME":"CAPRELSA 300 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"58487000321","LABEL_NAME":"KOBEE TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"58487001821","LABEL_NAME":"SUPER QUINTS B-50 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"58487003131","LABEL_NAME":"PRENATAL ONE DAILY TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"58602042324","LABEL_NAME":"LORATADINE 5 MG/5 ML SOLUTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"58605031316","LABEL_NAME":"MAXI-TUSS AC LIQUID","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"58607010359","LABEL_NAME":"MYNATAL CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"58607010565","LABEL_NAME":"MYNATAL-Z CAPTAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"58607012583","LABEL_NAME":"MYNATAL ULTRACAPLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"58607081120","LABEL_NAME":"MYNATAL PLUS CAPTAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"58657016012","LABEL_NAME":"SODIUM FLUORIDE 0.25 (0.55) MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"58657016110","LABEL_NAME":"SODIUM FLUORIDE 0.5 MG(1.1 MG)","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"58657016212","LABEL_NAME":"SODIUM FLUORIDE 1 MG (2.2 MG)","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"58657016301","LABEL_NAME":"MULTIVIT-FLUOR 0.25 MG TAB CHW","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"58657016401","LABEL_NAME":"MULTIVIT-FLUOR 0.5 MG TAB CHEW","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"58657016501","LABEL_NAME":"MULTIVIT-FLUORIDE 1 MG TAB CHW","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"58657017001","LABEL_NAME":"M-NATAL PLUS TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"58657032350","LABEL_NAME":"TRI-VITE-FLUORIDE 0.25 MG/ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"58657032450","LABEL_NAME":"TRI-VITE-FLUORIDE 0.5 MG/ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"58657050004","LABEL_NAME":"CODEINE-GUAIFEN 10-100 MG/5 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"58657050816","LABEL_NAME":"GUAIFENESIN 100 MG/5 ML SOLN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"58657052404","LABEL_NAME":"M-PAP 160 MG/5 ML LIQUID","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"58657052804","LABEL_NAME":"M-DRYL 12.5 MG/5 ML SOLUTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"58657081021","LABEL_NAME":"PYRIDOSTIGMINE BR 30 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"58980081810","LABEL_NAME":"AZOLEN 2% TINCTURE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"59011096201","LABEL_NAME":"ZURNAI 1.5 MG/0.5 ML AUTOINJCT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59088001554","LABEL_NAME":"FLOTREX 0.5 MG TABLET CHEW","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"59088001754","LABEL_NAME":"FLOTREX 0.25 MG TABLET CHEW","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"59088002054","LABEL_NAME":"FLOTREX 1 MG TABLET CHEW","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"59088010564","LABEL_NAME":"FLUORIDE 0.5 MG TABLET CHEW","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"59088010664","LABEL_NAME":"FLUORIDE 1 MG TABLET CHEWABLE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"59088044207","LABEL_NAME":"MYCOZYL AP 2% POWDER","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"59088090754","LABEL_NAME":"LIDOCAN III 5% PATCH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59088090954","LABEL_NAME":"LIDOCAN V 5% PATCH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59088091054","LABEL_NAME":"LIDOCAN IV 5% PATCH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59135000255","LABEL_NAME":"DROPLET INS 0.3ML 31G 6MM(1/2)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59135000257","LABEL_NAME":"DROPLET INS SYR 0.5 ML 31G 6MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59135000259","LABEL_NAME":"DROPLET INS SYR 1 ML 31G 6MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59135000261","LABEL_NAME":"DROPLET INS SYR 1 ML 31G 8MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59135000263","LABEL_NAME":"DROPLET INS SYR 0.5 ML 31G 8MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59135000265","LABEL_NAME":"DROPLET INS 0.3ML 31G 8MM(1/2)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59135000267","LABEL_NAME":"DROPLET INS SYR 1ML 30G 12.7MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59135000270","LABEL_NAME":"DROPLET INS 0.5 ML 30G 12.7MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59135000273","LABEL_NAME":"DROPLET 0.3 ML 30G 12.7MM(1/2)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59135000275","LABEL_NAME":"DROPLET INS SYR 1 ML 30G 8MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59135000277","LABEL_NAME":"DROPLET INS 0.3ML 30G 8MM(1/2)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59135000279","LABEL_NAME":"DROPLET INS SYR 0.5ML 30G 8MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59135000281","LABEL_NAME":"DROPLET INS SYR 1ML 29G 12.7MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59135000283","LABEL_NAME":"DROPLET INS 0.5 ML 29G 12.7MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59135000285","LABEL_NAME":"DROPLET 0.3 ML 29G 12.7MM(1/2)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59137050500","LABEL_NAME":"RASUVO 7.5 MG/0.15 ML AUTOINJ","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59137051000","LABEL_NAME":"RASUVO 10 MG/0.2 ML AUTOINJ","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59137051500","LABEL_NAME":"RASUVO 12.5 MG/0.25 ML AUTOINJ","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59137052000","LABEL_NAME":"RASUVO 15 MG/0.3 ML AUTOINJ","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59137052500","LABEL_NAME":"RASUVO 17.5 MG/0.35 ML AUTOINJ","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59137053000","LABEL_NAME":"RASUVO 20 MG/0.4 ML AUTOINJ","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59137053500","LABEL_NAME":"RASUVO 22.5 MG/0.45 ML AUTOINJ","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59137054000","LABEL_NAME":"RASUVO 25 MG/0.5 ML AUTOINJ","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59137055000","LABEL_NAME":"RASUVO 30 MG/0.6 ML AUTOINJ","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59148001870","LABEL_NAME":"ABILIFY MAINTENA ER 300 MG VL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59148001970","LABEL_NAME":"ABILIFY MAINTENA ER 400 MG VL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59148004580","LABEL_NAME":"ABILIFY MAINTENA ER 300 MG SYR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59148005316","LABEL_NAME":"NUEDEXTA 20-10 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59148007280","LABEL_NAME":"ABILIFY MAINTENA ER 400 MG SYR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59148010280","LABEL_NAME":"ABILIFY ASIMTUFII 720 MG/2.4ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59148011480","LABEL_NAME":"ABILIFY ASIMTUFII 960 MG/3.2ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59148040075","LABEL_NAME":"VOYXACT 400 MG/2 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59212060122","LABEL_NAME":"PANRETIN 0.1% GEL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59310030240","LABEL_NAME":"QVAR REDIHALER 40 MCG","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59310030480","LABEL_NAME":"QVAR REDIHALER 80 MCG","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59353040009","LABEL_NAME":"MIRCERA 30 MCG/0.3 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59353040109","LABEL_NAME":"MIRCERA 50 MCG/0.3 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59353040209","LABEL_NAME":"MIRCERA 75 MCG/0.3 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59353040309","LABEL_NAME":"MIRCERA 100 MCG/0.3 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59353040409","LABEL_NAME":"MIRCERA 150 MCG/0.3 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59353040709","LABEL_NAME":"MIRCERA 120 MCG/0.3 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59385002101","LABEL_NAME":"BELBUCA 75 MCG FILM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59385002201","LABEL_NAME":"BELBUCA 150 MCG FILM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59385002301","LABEL_NAME":"BELBUCA 300 MCG FILM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59385002401","LABEL_NAME":"BELBUCA 450 MCG FILM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59385002501","LABEL_NAME":"BELBUCA 600 MCG FILM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59385002601","LABEL_NAME":"BELBUCA 750 MCG FILM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59385002701","LABEL_NAME":"BELBUCA 900 MCG FILM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59385004130","LABEL_NAME":"SYMPROIC 0.2 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59390003022","LABEL_NAME":"ACNECLEAR GEL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"59390018118","LABEL_NAME":"TETRACAINE 0.5% EYE DROP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59390019205","LABEL_NAME":"HOMATROPAIRE 5% EYE DROPS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59390021702","LABEL_NAME":"CIPROFLOXACIN 0.3% EYE DROP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59467067901","LABEL_NAME":"KLOXXADO 8 MG NASAL SPRAY","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59519000202","LABEL_NAME":"TELCARE ULTRA THIN 30G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"59572020514","LABEL_NAME":"THALOMID 50 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59572021015","LABEL_NAME":"THALOMID 100 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59572050100","LABEL_NAME":"POMALYST 1 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59572050200","LABEL_NAME":"POMALYST 2 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59572050300","LABEL_NAME":"POMALYST 3 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59572050400","LABEL_NAME":"POMALYST 4 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59572070530","LABEL_NAME":"IDHIFA 50 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59572071030","LABEL_NAME":"IDHIFA 100 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59572072012","LABEL_NAME":"INREBIC 100 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59572073007","LABEL_NAME":"ONUREG 200 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59572074007","LABEL_NAME":"ONUREG 300 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59572081007","LABEL_NAME":"ZEPOSIA STARTER PACK (7-DAY)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59572082030","LABEL_NAME":"ZEPOSIA 0.92 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59572089028","LABEL_NAME":"ZEPOSIA STARTER KIT (28-DAY)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59617001502","LABEL_NAME":"ORALAIR 300 IR SUBLINGUAL TAB","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59627022205","LABEL_NAME":"AVONEX 30 MCG/0.5 ML SYR (4PK)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59627033304","LABEL_NAME":"AVONEX PEN 30 MCG/0.5 ML (4PK)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59651002601","LABEL_NAME":"AMOX-CLAV 250-62.5 MG/5 ML SUS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59651002928","LABEL_NAME":"LO-ZUMANDIMINE 3 MG-0.02 MG TB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59651003028","LABEL_NAME":"ZUMANDIMINE 3 MG-0.03 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59651013628","LABEL_NAME":"EMZAHH 0.35 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59651016530","LABEL_NAME":"EMTRICITABINE-TENOFV 100-150MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59651016630","LABEL_NAME":"EMTRICITABINE-TENOFV 133-200MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59651016730","LABEL_NAME":"EMTRICITABINE-TENOFV 167-250MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59651040217","LABEL_NAME":"MOMETASONE FUROATE 50 MCG SPRY","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59651048901","LABEL_NAME":"PREDNISONE 50 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59651072820","LABEL_NAME":"CEPHALEXIN 750 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59651084201","LABEL_NAME":"DICLOFENAC SOD DR 50 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59651084301","LABEL_NAME":"DICLOFENAC SOD DR 75 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59676003056","LABEL_NAME":"BALVERSA 3 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59676004028","LABEL_NAME":"BALVERSA 4 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59676005028","LABEL_NAME":"BALVERSA 5 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59676027801","LABEL_NAME":"EDURANT 25 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59676028001","LABEL_NAME":"EDURANT PED 2.5MG TAB FOR SUSP","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59676030200","LABEL_NAME":"PROCRIT 2,000 UNITS/ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59676030300","LABEL_NAME":"PROCRIT 3,000 UNITS/ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59676030400","LABEL_NAME":"PROCRIT 4,000 UNITS/ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59676031000","LABEL_NAME":"PROCRIT 10,000 UNITS/ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59676031200","LABEL_NAME":"PROCRIT 20,000 UNIT/2 ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59676032000","LABEL_NAME":"PROCRIT 20,000 UNITS/ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59676034000","LABEL_NAME":"PROCRIT 40,000 UNITS/ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59676056301","LABEL_NAME":"PREZISTA 75 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59676056401","LABEL_NAME":"PREZISTA 150 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59676056501","LABEL_NAME":"PREZISTA 100 MG/ML SUSPENSION","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59676057201","LABEL_NAME":"INTELENCE 25 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59676060012","LABEL_NAME":"ERLEADA 60 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59676060430","LABEL_NAME":"ERLEADA 240 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59707000100","LABEL_NAME":"SURE-JECT INSU SYR U100 1 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59707000101","LABEL_NAME":"SURE-JECT INSU SYR U100 0.5 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59707000102","LABEL_NAME":"SURE-JECT INSUL SYR U100 1 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59707000104","LABEL_NAME":"SURE-JECT INSU SYR U100 0.3 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59707000110","LABEL_NAME":"SURE-LANCE THIN 28G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"59707000112","LABEL_NAME":"SURE-LANCE ULTRA THIN 30G","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"59707000165","LABEL_NAME":"SURE-TOUCH LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"59707000166","LABEL_NAME":"SURE-LANCE FLAT LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"59707010001","LABEL_NAME":"SURE-PEN LANCING DEVICE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"59707013101","LABEL_NAME":"SURE-JECT INSULIN SYRINGE 1 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59707013130","LABEL_NAME":"SURE-JECT INS 0.3 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59707013150","LABEL_NAME":"SURE-JECT INS 0.5 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59707026101","LABEL_NAME":"SURE-LANCE 26G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"59746000204","LABEL_NAME":"METHYLPREDNISOLONE 8 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59746001504","LABEL_NAME":"METHYLPREDNISOLONE 32 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59762005001","LABEL_NAME":"METHYLPREDNISOLONE 16 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59762005701","LABEL_NAME":"ALPRAZOLAM XR 0.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59762005901","LABEL_NAME":"ALPRAZOLAM XR 1 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59762006601","LABEL_NAME":"ALPRAZOLAM XR 2 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59762006801","LABEL_NAME":"ALPRAZOLAM XR 3 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59762010405","LABEL_NAME":"SULFASALAZINE DR 500 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59762011901","LABEL_NAME":"PHENELZINE SULFATE 15 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59762013100","LABEL_NAME":"SILVER SULFADIAZINE 1% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59762054001","LABEL_NAME":"GLIPIZIDE XL 2.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59762054102","LABEL_NAME":"GLIPIZIDE XL 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59762305101","LABEL_NAME":"AZITHROMYCIN 1 GM PWD PACKET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59762600201","LABEL_NAME":"OXAPROZIN 600 MG CAPLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59767000401","LABEL_NAME":"PERTZYE DR 4,000 UNIT CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59767000801","LABEL_NAME":"PERTZYE DR 8,000 UNIT CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59767001601","LABEL_NAME":"PERTZYE DR 16,000 UNIT CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59767002401","LABEL_NAME":"PERTZYE DR 24,000 UNIT CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"59779006200","LABEL_NAME":"CVS CLOTRIMAZOLE-3 2% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"59779016110","LABEL_NAME":"CVS INFANT PAIN-FEVER 160 MG/5","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"59779019006","LABEL_NAME":"CVS NICOTINE 4 MG LOZENGE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"59779025503","LABEL_NAME":"CVS HYDROCORTISONE 1% OINTMENT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"59779028826","LABEL_NAME":"CVS CHILD'S CHEST CONGEST LIQ","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"59779030501","LABEL_NAME":"CVS CLOTRIMAZOLE 1% TOP CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"59779030652","LABEL_NAME":"CVS PURELAX POWDER PACKET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"59779033001","LABEL_NAME":"CVS ALLERGY 0.025% EYE DROPS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"59779036326","LABEL_NAME":"CVS CHILDREN'S COLD-COUGH LIQ","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"59779042098","LABEL_NAME":"CVS NICOTINE 2 MG CHEWING GUM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"59779044374","LABEL_NAME":"CVS NICOTINE 7 MG/24HR PATCH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"59779053664","LABEL_NAME":"CVS BACITRACIN 500 UNIT/G OINT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"59779057953","LABEL_NAME":"CVS CHILD FEVER RED 120 MG SUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"59779061239","LABEL_NAME":"CVS ALLERGY (LORAT) 10 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"59779070501","LABEL_NAME":"CVS EYE ITCH RELIEF 0.025% DRP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"59779083734","LABEL_NAME":"CVS CHILD ALLERGY RLF 1 MG/ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"60000052650","LABEL_NAME":"TRUE COMFORT 30G LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"60000052655","LABEL_NAME":"TRUE COMFORT 0.5 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60000052656","LABEL_NAME":"TRUE COMFORT 1 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60002025931","LABEL_NAME":"ULTRA FLO SYR 0.3 ML 29GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60002025933","LABEL_NAME":"ULTRA FLO 0.3ML 30G 1/2\" (1/2)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60002025934","LABEL_NAME":"ULTRA FLO SYR 0.3 ML 30G 5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60002025935","LABEL_NAME":"ULTRA FLO 0.3ML 30G 5/16\"(1/2)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60002025936","LABEL_NAME":"ULTRA FLO SYR 0.3 ML 31G 5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60002025937","LABEL_NAME":"ULTRA FLO SYR 0.5 ML 29G 1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60002025945","LABEL_NAME":"ULTRA FLO 0.3ML 31G 5/16\"(1/2)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60003012555","LABEL_NAME":"PURE COMFORT 30G TWIST LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"60003012556","LABEL_NAME":"PURE COMFORT 30G SAFETY LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"60006037784","LABEL_NAME":"TRUE COMFORT 30G SAFETY LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"60219158503","LABEL_NAME":"FLUOROMETHOLONE 0.1% EYE DROP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60219162101","LABEL_NAME":"METYROSINE 250 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60219167301","LABEL_NAME":"THIOTHIXENE 1 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60219167401","LABEL_NAME":"THIOTHIXENE 2 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60219167501","LABEL_NAME":"THIOTHIXENE 5 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60219167601","LABEL_NAME":"THIOTHIXENE 10 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60219255001","LABEL_NAME":"PREDNISOLONE AC 1% EYE DROP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60258015001","LABEL_NAME":"SF 5000 PLUS CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60258015101","LABEL_NAME":"SF 1.1% GEL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60258016001","LABEL_NAME":"RENA-VITE TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"60258017901","LABEL_NAME":"PRENATAL-U CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60258019001","LABEL_NAME":"PRENATABS FA TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60258019201","LABEL_NAME":"TRINATE TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60258019309","LABEL_NAME":"PRENATABS RX TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60505001406","LABEL_NAME":"DILT XR 120 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60505001506","LABEL_NAME":"DILT XR 180 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60505001606","LABEL_NAME":"DILT XR 240 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60505013300","LABEL_NAME":"CYCLOSPORINE 25 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60505013400","LABEL_NAME":"CYCLOSPORINE 100 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60505016401","LABEL_NAME":"FLUVOXAMINE MALEATE 25 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60505016501","LABEL_NAME":"FLUVOXAMINE MALEATE 50 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60505016601","LABEL_NAME":"FLUVOXAMINE MALEATE 100 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60505056401","LABEL_NAME":"BRIMONIDINE TARTRATE 0.15% DRP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60505058401","LABEL_NAME":"EPINASTINE HCL 0.05% EYE DROPS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60505280707","LABEL_NAME":"CARBAMAZEPINE ER 300 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60505325006","LABEL_NAME":"LAMIVUDINE HBV 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60505328506","LABEL_NAME":"RILUZOLE 50 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60505340905","LABEL_NAME":"QUINAPRIL-HCTZ 10-12.5 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60505341105","LABEL_NAME":"QUINAPRIL-HCTZ 20-25 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60505343803","LABEL_NAME":"SELEGILINE HCL 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60505621501","LABEL_NAME":"KETOTIFEN 0.025% (0.035%) DROP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"60758077305","LABEL_NAME":"KETOROLAC 0.4% OPHTH SOLUTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60758080205","LABEL_NAME":"TIMOLOL MALEATE 0.25% EYE DROP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60793085001","LABEL_NAME":"LEVOXYL 25 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60793085101","LABEL_NAME":"LEVOXYL 50 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60793085201","LABEL_NAME":"LEVOXYL 75 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60793085301","LABEL_NAME":"LEVOXYL 88 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60793085401","LABEL_NAME":"LEVOXYL 100 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60793085501","LABEL_NAME":"LEVOXYL 112 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60793085601","LABEL_NAME":"LEVOXYL 125 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60793085701","LABEL_NAME":"LEVOXYL 137 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60793085801","LABEL_NAME":"LEVOXYL 150 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60793085901","LABEL_NAME":"LEVOXYL 175 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60793086001","LABEL_NAME":"LEVOXYL 200 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60846080101","LABEL_NAME":"UNITHROID 25 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60846080201","LABEL_NAME":"UNITHROID 50 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60846080301","LABEL_NAME":"UNITHROID 75 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60846080401","LABEL_NAME":"UNITHROID 88 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60846080501","LABEL_NAME":"UNITHROID 100 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60846080601","LABEL_NAME":"UNITHROID 112 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60846080701","LABEL_NAME":"UNITHROID 125 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60846080801","LABEL_NAME":"UNITHROID 137 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60846080901","LABEL_NAME":"UNITHROID 150 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60846081001","LABEL_NAME":"UNITHROID 175 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60846081101","LABEL_NAME":"UNITHROID 200 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60846081201","LABEL_NAME":"UNITHROID 300 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60913000101","LABEL_NAME":"ASSURE COMFORT 30G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"60913000201","LABEL_NAME":"ASSURE COMFORT 28G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"60951060270","LABEL_NAME":"ENDOCET 5-325 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60951070070","LABEL_NAME":"ENDOCET 7.5-325 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60951070170","LABEL_NAME":"ENDOCET 2.5-325 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"60951071270","LABEL_NAME":"ENDOCET 10-325 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"61269032560","LABEL_NAME":"FOLTABS 800 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"61314004475","LABEL_NAME":"TRIFLURIDINE 1% EYE DROPS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"61314020315","LABEL_NAME":"PILOCARPINE 1% EYE DROPS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"61314020415","LABEL_NAME":"PILOCARPINE 2% EYE DROPS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"61314020615","LABEL_NAME":"PILOCARPINE 4% EYE DROPS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"61314023710","LABEL_NAME":"CROMOLYN 4% EYE DROPS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"61314023805","LABEL_NAME":"CARTEOLOL HCL 1% EYE DROPS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"61314024501","LABEL_NAME":"BETAXOLOL HCL 0.5% EYE DROP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"61314031801","LABEL_NAME":"ZARXIO 300 MCG/0.5 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"61314032601","LABEL_NAME":"ZARXIO 480 MCG/0.8 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"61314035401","LABEL_NAME":"TROPICAMIDE 0.5% EYE DROPS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"61314035501","LABEL_NAME":"TROPICAMIDE 1% EYE DROPS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"61314064175","LABEL_NAME":"NEOMYCIN-POLY-HC EYE DROPS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"61314066505","LABEL_NAME":"APRACLONIDINE HCL 0.5% DROPS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"61314086602","LABEL_NAME":"ZIEXTENZO 6 MG/0.6 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"61442010101","LABEL_NAME":"DICLOFENAC SOD DR 25 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"61442017130","LABEL_NAME":"CEFACLOR 250 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"61442017230","LABEL_NAME":"CEFACLOR 500 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"61703016102","LABEL_NAME":"METHOTREXATE 50 MG/2 ML VIAL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"61783000012","LABEL_NAME":"FC2 FEMALE CONDOM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"61874007560","LABEL_NAME":"VIBERZI 75 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"61874010060","LABEL_NAME":"VIBERZI 100 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"61958040401","LABEL_NAME":"VIREAD 150 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"61958040501","LABEL_NAME":"VIREAD 200 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"61958040601","LABEL_NAME":"VIREAD 250 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"61958060201","LABEL_NAME":"EMTRIVA 10 MG/ML SOLUTION","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"61958090101","LABEL_NAME":"CAYSTON 75 MG INHAL SOLUTION","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"61958120101","LABEL_NAME":"STRIBILD TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"61958140101","LABEL_NAME":"TYBOST 150 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"61958150101","LABEL_NAME":"SOVALDI 400 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"61958150301","LABEL_NAME":"SOVALDI 200 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"61958150401","LABEL_NAME":"SOVALDI 150 MG PELLET PACKET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"61958150501","LABEL_NAME":"SOVALDI 200 MG PELLET PACKET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"61958170101","LABEL_NAME":"ZYDELIG 100 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"61958170201","LABEL_NAME":"ZYDELIG 150 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"61958180101","LABEL_NAME":"HARVONI 90-400 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"61958180301","LABEL_NAME":"HARVONI 45-200 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"61958180401","LABEL_NAME":"HARVONI 45-200 MG PELLET PACKT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"61958180501","LABEL_NAME":"HARVONI 33.75-150 MG PELLET PK","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"61958190101","LABEL_NAME":"GENVOYA TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"61958200201","LABEL_NAME":"DESCOVY 200-25 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"61958200501","LABEL_NAME":"DESCOVY 120-15 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"61958210101","LABEL_NAME":"ODEFSEY TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"61958220101","LABEL_NAME":"EPCLUSA 400 MG-100 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"61958220301","LABEL_NAME":"EPCLUSA 200 MG-50 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"61958220401","LABEL_NAME":"EPCLUSA 200-50 MG PELLET PACK","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"61958220501","LABEL_NAME":"EPCLUSA 150-37.5 MG PELLET PKT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"61958230101","LABEL_NAME":"VEMLIDY 25 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"61958240101","LABEL_NAME":"VOSEVI 400-100-100 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"61958250101","LABEL_NAME":"BIKTARVY 50-200-25 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"61958250501","LABEL_NAME":"BIKTARVY 30-120-15 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"61958330102","LABEL_NAME":"LIVDELZI 10 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62037059705","LABEL_NAME":"CARTIA XT 120 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62037059805","LABEL_NAME":"CARTIA XT 180 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62037059905","LABEL_NAME":"CARTIA XT 240 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62037060005","LABEL_NAME":"CARTIA XT 300 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62064024130","LABEL_NAME":"EGRIFTA SV 2 MG VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62064037101","LABEL_NAME":"EGRIFTA WR 11.6 MG VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62064038104","LABEL_NAME":"EGRIFTA WR 11.6MG FOUR-VL KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62135005024","LABEL_NAME":"HYDROXYZINE 50 MG/25 ML CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62135011437","LABEL_NAME":"DEXAMETHASONE 0.5 MG/5 ML ELX","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62135018941","LABEL_NAME":"ALBUTEROL SULF 2 MG/5 ML SYRUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62135026001","LABEL_NAME":"DOXYCYCLINE MONO 50 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62135026225","LABEL_NAME":"DOXYCYCLINE MONO 100 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62135051147","LABEL_NAME":"HYOSCYAMINE 0.125 MG/5 ML ELIX","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62135052005","LABEL_NAME":"OXYBUTYNIN 5 MG/5 ML SOLN CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62135052047","LABEL_NAME":"OXYBUTYNIN 5 MG/5 ML SOLUTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62135052647","LABEL_NAME":"METOCLOPRAMIDE 5 MG/5 ML SOLN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62135066890","LABEL_NAME":"QUINAPRIL-HCTZ 20-12.5 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62135073630","LABEL_NAME":"FLURAZEPAM 15 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62135073730","LABEL_NAME":"FLURAZEPAM 30 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62135074947","LABEL_NAME":"SULFAMETHOXAZOLE-TMP SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62135076843","LABEL_NAME":"DIAZEPAM 25 MG/5 ML ORAL CONC","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62135077330","LABEL_NAME":"TRIMETHOBENZAMIDE 300 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62135077405","LABEL_NAME":"PROMETHAZINE 6.25 MG/5 ML CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62135077410","LABEL_NAME":"PROMETHAZINE 12.5 MG/10 ML CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62135080224","LABEL_NAME":"CARBAMAZEPINE 100 MG/5 ML CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62135080905","LABEL_NAME":"CIMETIDINE 300 MG/5 ML CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62135087746","LABEL_NAME":"DOXYCYCLINE 25 MG/5 ML SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62135089247","LABEL_NAME":"GENERLAC 10 GM/15 ML SOLUTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62135094947","LABEL_NAME":"CYPROHEPTADINE 2 MG/5 ML SYRUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62135096630","LABEL_NAME":"DAPSONE 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62250061902","LABEL_NAME":"DESLORATADINE 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62332001931","LABEL_NAME":"MEPROBAMATE 200 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62332002031","LABEL_NAME":"MEPROBAMATE 400 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62332038931","LABEL_NAME":"NITROFURANTOIN MCR 25 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62332050817","LABEL_NAME":"BROMFENAC SODIUM 0.09% EYE DRP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62441040010","LABEL_NAME":"FENESIN IR 400 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"62541040110","LABEL_NAME":"PANCREAZE DR 2,600 UNIT CAP","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62541040210","LABEL_NAME":"PANCREAZE DR 4,200 UNIT CAP","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62541040310","LABEL_NAME":"PANCREAZE DR 10,500 UNIT CAP","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62541040410","LABEL_NAME":"PANCREAZE DR 16,800 UNIT CAP","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62541040510","LABEL_NAME":"PANCREAZE DR 21,000 UNIT CAP","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62541040610","LABEL_NAME":"PANCREAZE DR 37,000 UNIT CAP","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62542030030","LABEL_NAME":"MULTIVIT-FLUOR 0.5 MG TAB CHEW","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"62542080550","LABEL_NAME":"MULTIVIT-FLUOR 0.25 MG/ML DROP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"62559017331","LABEL_NAME":"NILUTAMIDE 150 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62559043130","LABEL_NAME":"HYDROCORTISONE 2.5% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62559086011","LABEL_NAME":"CORTROPHIN GEL 80 UNIT/ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62559086015","LABEL_NAME":"CORTROPHIN GEL 400 UNIT/5 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62559086111","LABEL_NAME":"CORTROPHIN GEL 80 UNIT/ML SYR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62559086135","LABEL_NAME":"CORTROPHIN GEL 40 UNIT/0.5 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62756029983","LABEL_NAME":"PHENYTOIN SOD EXT 200 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62756034844","LABEL_NAME":"OCTREOTIDE ACET 50 MCG/ML AMP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62756034944","LABEL_NAME":"OCTREOTIDE ACET 100 MCG/ML AMP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62756035144","LABEL_NAME":"OCTREOTIDE ACET 500 MCG/ML AMP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62756043283","LABEL_NAME":"PHENYTOIN SOD EXT 300 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62756045236","LABEL_NAME":"BYNFEZIA 7,000 MCG/2.8 ML PEN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62756071860","LABEL_NAME":"OPCICON ONE-STEP 1.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"62756072060","LABEL_NAME":"MY CHOICE 1.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"62850000002","LABEL_NAME":"ULTRA THIN 31G LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"62856022001","LABEL_NAME":"LEQEMBI IQLIK 360 MG/1.8 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62856070405","LABEL_NAME":"LENVIMA 4 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62856070805","LABEL_NAME":"LENVIMA 8 MG DAILY DOSE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62856071005","LABEL_NAME":"LENVIMA 10 MG DAILY DOSE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62856071205","LABEL_NAME":"LENVIMA 12 MG DAILY DOSE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62856071405","LABEL_NAME":"LENVIMA 14 MG DAILY DOSE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62856071805","LABEL_NAME":"LENVIMA 18 MG DAILY DOSE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62856072005","LABEL_NAME":"LENVIMA 20 MG DAILY DOSE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62856072405","LABEL_NAME":"LENVIMA 24 MG DAILY DOSE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62935015350","LABEL_NAME":"FENSOLVI 45 MG SYRINGE KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62935022305","LABEL_NAME":"ELIGARD 22.5 MG SYRINGE KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62935030330","LABEL_NAME":"ELIGARD 30 MG SYRINGE KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62935045345","LABEL_NAME":"ELIGARD 45 MG SYRINGE KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"62935075375","LABEL_NAME":"ELIGARD 7.5 MG SYRINGE KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"63004871001","LABEL_NAME":"ACTHAR GEL 400 UNIT/5 ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"63004871101","LABEL_NAME":"ACTHAR 80 UNIT/ML SELFJECT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"63004871201","LABEL_NAME":"ACTHAR 40 UNIT/0.5 ML SELFJECT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"63010001030","LABEL_NAME":"VIRACEPT 250 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"63010002770","LABEL_NAME":"VIRACEPT 625 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"63020009007","LABEL_NAME":"ALUNBRIG 90 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"63020011330","LABEL_NAME":"ALUNBRIG 30 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"63020018030","LABEL_NAME":"ALUNBRIG 180 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"63020019830","LABEL_NAME":"ALUNBRIG 90 MG-180 MG TAB PACK","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"63020021021","LABEL_NAME":"FRUZAQLA 1 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"63020022521","LABEL_NAME":"FRUZAQLA 5 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"63020023001","LABEL_NAME":"NINLARO 2.3 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"63020039001","LABEL_NAME":"NINLARO 3 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"63020040001","LABEL_NAME":"NINLARO 4 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"63020053330","LABEL_NAME":"ICLUSIG 30 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"63020053430","LABEL_NAME":"ICLUSIG 45 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"63020053530","LABEL_NAME":"ICLUSIG 15 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"63020053630","LABEL_NAME":"ICLUSIG 10 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"63044063510","LABEL_NAME":"TRICON CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"63090010030","LABEL_NAME":"NUPLAZID 10 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"63090034030","LABEL_NAME":"NUPLAZID 34 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"63090066001","LABEL_NAME":"DAYBUE 200 MG/ML SOLUTION","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"63304008913","LABEL_NAME":"MESALAMINE ER 500 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"63323003010","LABEL_NAME":"CHORIONIC GONAD 10,000 UNIT VL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"63323012310","LABEL_NAME":"METHOTREXATE 250 MG/10 ML VIAL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"63323028110","LABEL_NAME":"FLUPHENAZINE 2.5 MG/ML VIAL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"63323054204","LABEL_NAME":"HEPARIN 50,000 UNIT/5 ML VIAL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"63323081504","LABEL_NAME":"AMIKACIN SULF 1,000 MG/4 ML VL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"63361024310","LABEL_NAME":"VAXELIS VACCINE VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"63361024315","LABEL_NAME":"VAXELIS VACCINE SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"63459091011","LABEL_NAME":"GRANIX 300 MCG/0.5 ML SAFE SYR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"63459091017","LABEL_NAME":"GRANIX 300 MCG/0.5 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"63459091211","LABEL_NAME":"GRANIX 480 MCG/0.8 ML SAFE SYR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"63459091217","LABEL_NAME":"GRANIX 480 MCG/0.8 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"63459091853","LABEL_NAME":"GRANIX 300 MCG/ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"63704002001","LABEL_NAME":"CAYA CONTOURED DIAPHRAGM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"63736044700","LABEL_NAME":"MONISTAT CARE 1% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"63824005400","LABEL_NAME":"SCALPICIN 1% ANTI-ITCH LIQUID","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"63833082802","LABEL_NAME":"HAEGARDA 2,000 UNIT VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"63833082902","LABEL_NAME":"HAEGARDA 3,000 UNIT VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"63833092501","LABEL_NAME":"ANDEMBRY 200 MG/1.2 ML AUTOINJ","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"63868000214","LABEL_NAME":"QC NATURA-LAX 17 GM POWDER","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"63868008410","LABEL_NAME":"QC PAIN RELIEF 500 MG CAPLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"63868008724","LABEL_NAME":"QC COMPLETE ALLERGY 25 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"63868017418","LABEL_NAME":"QC CHILD PAIN RLF 160 MG/5 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"63868018624","LABEL_NAME":"QC CHILD NON-ASPIRIN 160MG CHW","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"63868019845","LABEL_NAME":"QC MICONAZOLE-7 CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"63868031012","LABEL_NAME":"QC MILK OF MAGNESIA SUSPENSION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"63868036320","LABEL_NAME":"QC ASPIRIN EC 81 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"63868037004","LABEL_NAME":"QC CHILD ALLERGY 12.5 MG/5 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"63868041401","LABEL_NAME":"QC ALLERGY (LORAT) 10 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"63868047424","LABEL_NAME":"QC ALLERGY (DIPHEN) 25 MG SFGL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"63868067760","LABEL_NAME":"QC INFANT PAIN-FEVER 160 MG/5","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"63868067950","LABEL_NAME":"QC 8 HOUR PAIN RLF ER 650 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"63868077324","LABEL_NAME":"QC IBUPROFEN 200 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"63868079504","LABEL_NAME":"QC CHILD IBUPROFEN 100 MG/5 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"63868082125","LABEL_NAME":"QC OLOPATADINE 0.2% EYE DROP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"63868082354","LABEL_NAME":"QC CHILD ALLERGY 12.5 MG/5 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"63868098710","LABEL_NAME":"QC NON-ASPIRIN 500 MG GELCAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"63868098750","LABEL_NAME":"QC NON-ASPIRIN 500 MG GELCAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"63868099850","LABEL_NAME":"QC MUCUS RELIEF 400 MG CAPLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"63981000101","LABEL_NAME":"ALLER-FLO 50 MCG SPRAY","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"63981002901","LABEL_NAME":"QUIT 2 MG CHEWING GUM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"63981012409","LABEL_NAME":"QUIT 2 MG LOZENGE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"63981017001","LABEL_NAME":"QUIT 4 MG CHEWING GUM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"63981019009","LABEL_NAME":"QUIT 4 MG LOZENGE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"63981030604","LABEL_NAME":"LAXACLEAR POWDER","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"63981030607","LABEL_NAME":"LAXACLEAR POWDER","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"63981044301","LABEL_NAME":"ALLER-CORT 55 MCG NASAL SPRAY","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"63981045888","LABEL_NAME":"ALLER-TEC 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"63981061288","LABEL_NAME":"ALLERCLEAR 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"64122060501","LABEL_NAME":"AFTER PILL 1.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"64370037501","LABEL_NAME":"HEMANGEOL 4.28 MG/ML ORAL SOLN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"64380016001","LABEL_NAME":"MEGESTROL ACET 40 MG/ML SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"64380016901","LABEL_NAME":"IMIPRAMINE HCL 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"64380017001","LABEL_NAME":"IMIPRAMINE HCL 25 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"64380017101","LABEL_NAME":"IMIPRAMINE HCL 50 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"64380075216","LABEL_NAME":"METHOXSALEN 10 MG SOFTGEL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"64406001101","LABEL_NAME":"PLEGRIDY 125 MCG/0.5 ML PEN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"64406001201","LABEL_NAME":"PLEGRIDY PEN INJ STARTER PACK","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"64406001501","LABEL_NAME":"PLEGRIDY 125 MCG/0.5 ML SYRING","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"64406001601","LABEL_NAME":"PLEGRIDY SYRINGE STARTER PACK","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"64406001701","LABEL_NAME":"PLEGRIDY 125 MCG/0.5 ML SYRING","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"64406002003","LABEL_NAME":"VUMERITY DR 231 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"64406002901","LABEL_NAME":"ZURZUVAE 20 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"64406003002","LABEL_NAME":"ZURZUVAE 25 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"64406003101","LABEL_NAME":"ZURZUVAE 30 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"64406025090","LABEL_NAME":"SKYCLARYS 50 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"64764010510","LABEL_NAME":"EOHILIA 2 MG/10 ML PACKET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"64764010820","LABEL_NAME":"ENTYVIO 108 MG/0.68 ML PEN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"64764080028","LABEL_NAME":"LIVTENCITY 200 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"64842012004","LABEL_NAME":"LYTGOBI 12 MG DOSE (3X 4MG TB)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"64842012005","LABEL_NAME":"LYTGOBI 16 MG DOSE (4X 4MG TB)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"64842012006","LABEL_NAME":"LYTGOBI 20 MG DOSE (5X 4MG TB)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"64842072709","LABEL_NAME":"INQOVI 35 MG-100 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"64842102001","LABEL_NAME":"LONSURF 20 MG-8.19 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"64842102501","LABEL_NAME":"LONSURF 15 MG-6.14 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"64896040201","LABEL_NAME":"ONGENTYS 25 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"64896040301","LABEL_NAME":"ONGENTYS 50 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"64896066930","LABEL_NAME":"EMVERM 100 MG TABLET CHEW","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"64896069501","LABEL_NAME":"OXYMORPHONE HCL ER 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"64896069601","LABEL_NAME":"OXYMORPHONE HCL ER 7.5 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"64896069701","LABEL_NAME":"OXYMORPHONE HCL ER 10 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"64896069801","LABEL_NAME":"OXYMORPHONE HCL ER 15 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"64896069901","LABEL_NAME":"OXYMORPHONE HCL ER 20 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"64896070001","LABEL_NAME":"OXYMORPHONE HCL ER 30 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"64896070101","LABEL_NAME":"OXYMORPHONE HCL ER 40 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"64950021810","LABEL_NAME":"FLURBIPROFEN 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"64950026810","LABEL_NAME":"CLEMASTINE FUM 2.68 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"64950034316","LABEL_NAME":"HYDROCODONE-ACETAMN 7.5-325/15","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"64950034516","LABEL_NAME":"PROMETHAZINE-PE 6.25-5 MG/5 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"64950037416","LABEL_NAME":"ACETAMINOP-CODEINE 120-12 MG/5","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"64950037516","LABEL_NAME":"HYDROCODONE-ACETAMIN 10-325/15","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"64980032430","LABEL_NAME":"PROCTOZONE-HC 2.5% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"64980032801","LABEL_NAME":"ERYTHROMYCIN-BENZOYL GEL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"64980040403","LABEL_NAME":"TOREMIFENE CITRATE 60 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"64980052603","LABEL_NAME":"NITAZOXANIDE 500 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"64980059248","LABEL_NAME":"LACTULOSE 10 GM/15 ML SOLUTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"64980063603","LABEL_NAME":"RANITIDINE 150 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"64980063703","LABEL_NAME":"RANITIDINE 300 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65162012604","LABEL_NAME":"LYLLANA 0.025 MG PATCH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65162014804","LABEL_NAME":"LYLLANA 0.0375 MG PATCH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65162014904","LABEL_NAME":"LYLLANA 0.05 MG PATCH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65162015004","LABEL_NAME":"LYLLANA 0.075 MG PATCH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65162022804","LABEL_NAME":"LYLLANA 0.1 MG PATCH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65162046932","LABEL_NAME":"ELURYNG VAGINAL RING","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65162098904","LABEL_NAME":"DOTTI 0.025 MG PATCH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65162099204","LABEL_NAME":"DOTTI 0.0375 MG PATCH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65162099304","LABEL_NAME":"DOTTI 0.05 MG PATCH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65162099504","LABEL_NAME":"DOTTI 0.075 MG PATCH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65162099704","LABEL_NAME":"DOTTI 0.1 MG PATCH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65219037110","LABEL_NAME":"STIMUFEND 6 MG/0.6 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65219059601","LABEL_NAME":"TYENNE 162 MG/0.9 ML AUTOINJCT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65219059810","LABEL_NAME":"TYENNE 162 MG/0.9 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65597040720","LABEL_NAME":"TURALIO 125 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65597050404","LABEL_NAME":"VANFLYTA 17.7 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65597051104","LABEL_NAME":"VANFLYTA 26.5 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65628007003","LABEL_NAME":"FIRST-OMEPRAZOLE 2 MG/ML SUSP","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65628008003","LABEL_NAME":"FIRST-LANSOPRAZOLE 3 MG/ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65649000330","LABEL_NAME":"TRULANCE 3 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65649015090","LABEL_NAME":"RELISTOR 150 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65649030103","LABEL_NAME":"XIFAXAN 200 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65649030302","LABEL_NAME":"XIFAXAN 550 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65649031112","LABEL_NAME":"DIURIL 250 MG/5 ML ORAL SUSP","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65649055102","LABEL_NAME":"RELISTOR 12 MG/0.6 ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65649055103","LABEL_NAME":"RELISTOR 12 MG/0.6 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65649055204","LABEL_NAME":"RELISTOR 8 MG/0.4 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65702028810","LABEL_NAME":"ACCU-CHEK FASTCLIX LANCET DRUM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"65702040010","LABEL_NAME":"ACCU-CHEK SOFTCLIX LANCET KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"65702048110","LABEL_NAME":"ACCU-CHEK FASTCLIX LANCING DEV","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"65757030001","LABEL_NAME":"VIVITROL 380 MG VIAL-DILUENT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65757040103","LABEL_NAME":"ARISTADA ER 441 MG/1.6 ML SYRN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65757040203","LABEL_NAME":"ARISTADA ER 662 MG/2.4 ML SYRN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65757040303","LABEL_NAME":"ARISTADA ER 882 MG/3.2 ML SYRN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65757040403","LABEL_NAME":"ARISTADA ER 1064 MG/3.9 ML SYR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65757050003","LABEL_NAME":"ARISTADA INITIO ER 675 MG/2.4","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65862004824","LABEL_NAME":"ZIDOVUDINE 50 MG/5 ML SYRUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65862005724","LABEL_NAME":"NEVIRAPINE 50 MG/5 ML SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65862020768","LABEL_NAME":"RIBAVIRIN 200 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65862028601","LABEL_NAME":"PERINDOPRIL ERBUMINE 2 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65862028701","LABEL_NAME":"PERINDOPRIL ERBUMINE 4 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65862028801","LABEL_NAME":"PERINDOPRIL ERBUMINE 8 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65862029018","LABEL_NAME":"RIBAVIRIN 200 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65862030130","LABEL_NAME":"EMTRICITABINE 200 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65862045460","LABEL_NAME":"ALPRAZOLAM ER 0.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65862045560","LABEL_NAME":"ALPRAZOLAM ER 1 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65862045660","LABEL_NAME":"ALPRAZOLAM ER 2 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65862045760","LABEL_NAME":"ALPRAZOLAM ER 3 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65862075150","LABEL_NAME":"CEFIXIME 100 MG/5 ML SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65862075250","LABEL_NAME":"CEFIXIME 200 MG/5 ML SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65862077628","LABEL_NAME":"MILI 0.25-0.035 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65862077728","LABEL_NAME":"TRI-MILI 28 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65862077828","LABEL_NAME":"TRI-LO-MILI TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65862084828","LABEL_NAME":"AYUNA-28 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65862084928","LABEL_NAME":"AFIRMELLE-28 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65862086494","LABEL_NAME":"SIMPESSE 0.15-0.03-0.01 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65862086583","LABEL_NAME":"ICLEVIA 0.15 MG-0.03 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65862088628","LABEL_NAME":"SIMLIYA 28 DAY TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65862088728","LABEL_NAME":"KALLIGA 28 DAY TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65862089728","LABEL_NAME":"NYLIA 7-7-7-28 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65862089888","LABEL_NAME":"NYLIA 1-35 28 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65862092585","LABEL_NAME":"INCASSIA 0.35 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65862093290","LABEL_NAME":"NEVIRAPINE ER 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65862093487","LABEL_NAME":"AUROVELA 24 FE 1 MG-20 MCG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65862093521","LABEL_NAME":"AUROVELA 21 1.5-30 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65862093921","LABEL_NAME":"AUROVELA 1 MG-20 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65862094087","LABEL_NAME":"AUROVELA FE 1-20 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"65862094188","LABEL_NAME":"AUROVELA FE 1.5 MG-30 MCG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"66019011200","LABEL_NAME":"FLUMIST 2025-2026 NASAL SPRAY","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"66019011251","LABEL_NAME":"FLUMIST HOME 2025-2026 NASAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"66215050115","LABEL_NAME":"OPSUMIT 10 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"66215060214","LABEL_NAME":"UPTRAVI 200 MCG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"66215060406","LABEL_NAME":"UPTRAVI 400 MCG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"66215060606","LABEL_NAME":"UPTRAVI 600 MCG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"66215060806","LABEL_NAME":"UPTRAVI 800 MCG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"66215061006","LABEL_NAME":"UPTRAVI 1,000 MCG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"66215061206","LABEL_NAME":"UPTRAVI 1,200 MCG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"66215061406","LABEL_NAME":"UPTRAVI 1,400 MCG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"66215061606","LABEL_NAME":"UPTRAVI 1,600 MCG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"66215062820","LABEL_NAME":"UPTRAVI 200-800 TITRATION PACK","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"66215081201","LABEL_NAME":"OPSYNVI 10-20 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"66215081401","LABEL_NAME":"OPSYNVI 10-40 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"66302020601","LABEL_NAME":"TYVASO INHALATION STARTER KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"66302020602","LABEL_NAME":"TYVASO INHALATION REFILL KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"66302020603","LABEL_NAME":"TYVASO 1.74 MG/2.9 ML SOLUTION","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"66302020604","LABEL_NAME":"TYVASO INSTITUTIONAL START KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"66302030001","LABEL_NAME":"ORENITRAM ER 0.125 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"66302030201","LABEL_NAME":"ORENITRAM ER 0.25 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"66302031001","LABEL_NAME":"ORENITRAM ER 1 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"66302032501","LABEL_NAME":"ORENITRAM ER 2.5 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"66302035001","LABEL_NAME":"ORENITRAM ER 5 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"66302036128","LABEL_NAME":"ORENITRAM MONTH 1 TITRATION KT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"66302036256","LABEL_NAME":"ORENITRAM MONTH 2 TITRATION KT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"66302036384","LABEL_NAME":"ORENITRAM MONTH 3 TITRATION KT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"66302061002","LABEL_NAME":"TYVASO DPI 16-32-48 MCG TITRAT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"66302061603","LABEL_NAME":"TYVASO DPI 16 MCG CARTRIDGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"66302063003","LABEL_NAME":"TYVASO DPI 32-64 MCG MAINT KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"66302064003","LABEL_NAME":"TYVASO DPI 48-64 MCG MAINT KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"66302066403","LABEL_NAME":"TYVASO DPI 64 MCG CARTRIDGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"66302068003","LABEL_NAME":"TYVASO DPI 80 MCG CARTRIDGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"66302073204","LABEL_NAME":"TYVASO DPI 32 MCG CARTRIDGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"66302074804","LABEL_NAME":"TYVASO DPI 48 MCG CARTRIDGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"66658020490","LABEL_NAME":"ORFADIN 4 MG/ML SUSPENSION","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"66658023401","LABEL_NAME":"KINERET 100 MG/0.67 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"66758007138","LABEL_NAME":"CILOXAN 0.3% OINTMENT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"66758010111","LABEL_NAME":"HYCAMTIN 0.25 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"66758010211","LABEL_NAME":"HYCAMTIN 1 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"66992020830","LABEL_NAME":"ZONTIVITY 2.08 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"66993019544","LABEL_NAME":"TOBRAMYCIN 300 MG/4 ML AMPULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"66993037202","LABEL_NAME":"PHENYTOIN 50 MG INFATAB CHEW","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"67405083506","LABEL_NAME":"BENZOYL PEROXIDE 6% CLEANSER","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"67457023900","LABEL_NAME":"OCTREOTIDE ACET 50 MCG/ML SYR","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"67457024500","LABEL_NAME":"OCTREOTIDE ACET 100 MCG/ML SYR","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"67457024600","LABEL_NAME":"OCTREOTIDE ACET 500 MCG/ML SYR","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"67457083306","LABEL_NAME":"FULPHILA 6 MG/0.6 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"67546021221","LABEL_NAME":"ALINIA 100 MG/5 ML SUSPENSION","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"67871011105","LABEL_NAME":"SUCRAID 17,000 UNIT/2 ML SOLN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"67877058433","LABEL_NAME":"CEFIXIME 400 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"67877088271","LABEL_NAME":"RIVAROXABAN 1 MG/ML SUSPENSION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"67919004104","LABEL_NAME":"SIVEXTRO 200 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"67979000201","LABEL_NAME":"SUPPRELIN LA 50 MG KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68016016201","LABEL_NAME":"PV AUTOLET LANCING DEVICE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"68016030554","LABEL_NAME":"PV UNILET SUPER THIN 30G LANCT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"68016073800","LABEL_NAME":"PV UNILET MICRO THIN 33G LANCT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"68047014316","LABEL_NAME":"ENDACOF-DM LIQUID","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"68047025201","LABEL_NAME":"OSCIMIN 0.125 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68047025301","LABEL_NAME":"OSCIMIN SL 0.125 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68094000459","LABEL_NAME":"CETIRIZINE HCL 5 MG/5 ML CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"68094003701","LABEL_NAME":"CHILD IBUPROFEN 100MG/5ML SYRG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"68094023159","LABEL_NAME":"ACETAMINOPHEN 160 MG/5 ML CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"68135005889","LABEL_NAME":"PALYNZIQ 2.5 MG/0.5 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68135008236","LABEL_NAME":"VOXZOGO 0.4 MG VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68135011966","LABEL_NAME":"VOXZOGO 0.56 MG VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68135018193","LABEL_NAME":"VOXZOGO 1.2 MG VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68135067339","LABEL_NAME":"PALYNZIQ 20 MG/ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68135075619","LABEL_NAME":"PALYNZIQ 10 MG/0.5 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68180015106","LABEL_NAME":"MIRABEGRON ER 25 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68180015206","LABEL_NAME":"MIRABEGRON ER 50 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68180034013","LABEL_NAME":"BOSENTAN 32 MG TABLET FOR SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68180073971","LABEL_NAME":"ENSKYCE 28 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68180082709","LABEL_NAME":"FYAVOLV 0.5 MG-2.5 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68180082809","LABEL_NAME":"FYAVOLV 1 MG-5 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68180083771","LABEL_NAME":"TRI-LO-MARZIA TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68180084471","LABEL_NAME":"KURVELO-28 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68180084611","LABEL_NAME":"DAYSEE 0.15-0.03-0.01 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68180084811","LABEL_NAME":"LEVONOR-E ESTRAD 0.1-0.02-0.01","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68180085211","LABEL_NAME":"MY WAY 1.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"68180085771","LABEL_NAME":"LEVONOR-ETH ESTRAD TRIPHASIC","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68180086471","LABEL_NAME":"BLISOVI 24 FE TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68180086571","LABEL_NAME":"BLISOVI FE 1-20 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68180086911","LABEL_NAME":"BLISOVI FE 1.5-30 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68180087371","LABEL_NAME":"WYMZYA FE 0.4-0.035 MG CHEW TB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68180087571","LABEL_NAME":"VYFEMLA 0.4 MG-0.035 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68180087771","LABEL_NAME":"JENCYCLA 0.35 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68180088671","LABEL_NAME":"NIKKI 3 MG-0.02 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68180090371","LABEL_NAME":"KAITLIB FE 0.8-0.025MG CHEW TB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68180090471","LABEL_NAME":"TYDEMY 3-0.03-0.451 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68180091171","LABEL_NAME":"MIBELAS 24 FE CHEWABLE TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68196040102","LABEL_NAME":"BLULINK BG SYSTEM REFILL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"68308075030","LABEL_NAME":"BIJUVA 1 MG-100 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68308075130","LABEL_NAME":"BIJUVA 0.5 MG-100 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68382074516","LABEL_NAME":"TIADYLT ER 120 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68382074616","LABEL_NAME":"TIADYLT ER 180 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68382074716","LABEL_NAME":"TIADYLT ER 240 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68382074816","LABEL_NAME":"TIADYLT ER 300 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68382074916","LABEL_NAME":"TIADYLT ER 360 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68382075016","LABEL_NAME":"TIADYLT ER 420 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68418793906","LABEL_NAME":"DIACOMIT 250 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68418794006","LABEL_NAME":"DIACOMIT 500 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68418794106","LABEL_NAME":"DIACOMIT 250 MG POWDER PACKET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68418794206","LABEL_NAME":"DIACOMIT 500 MG POWDER PACKET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68462029401","LABEL_NAME":"TRANDOLAPR-VERAPAM ER 1-240 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68462029501","LABEL_NAME":"TRANDOLAPR-VERAPAM ER 2-180 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68462029601","LABEL_NAME":"TRANDOLAPR-VERAPAM ER 2-240 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68462030329","LABEL_NAME":"HEATHER 0.35 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68462031629","LABEL_NAME":"BRIELLYN TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68462031829","LABEL_NAME":"VIORELE 28 DAY TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68462032901","LABEL_NAME":"TRANDOLAPR-VERAPAM ER 4-240 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68462035601","LABEL_NAME":"THEOPHYLLINE ER 600 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68462038829","LABEL_NAME":"MARLISSA-28 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68462039429","LABEL_NAME":"ALYACEN 1-35 28 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68462041929","LABEL_NAME":"HAILEY FE 1-20 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68462050329","LABEL_NAME":"HAILEY FE 1.5-30 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68462050479","LABEL_NAME":"HAILEY 21 1.5 MG-30 MCG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68462055629","LABEL_NAME":"ALYACEN 7-7-7-28 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68462063729","LABEL_NAME":"LEVONOR-ETH ESTRA 0.09-0.02 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68462064691","LABEL_NAME":"ASHLYNA 0.15-0.03-0.01 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68462065629","LABEL_NAME":"NORETHIND-ETH ESTRAD 0.5-2.5","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68462065729","LABEL_NAME":"NORETHIN-ETH ESTRAD 1 MG-5 MCG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68462073129","LABEL_NAME":"HAILEY 24 FE 1 MG-20 MCG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68462085229","LABEL_NAME":"CHARLOTTE 24 FE CHEWABLE TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68462089404","LABEL_NAME":"VARENICLINE 1 MG CONT MONTH BX","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68546017060","LABEL_NAME":"AUSTEDO 6 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68546017160","LABEL_NAME":"AUSTEDO 9 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68546017260","LABEL_NAME":"AUSTEDO 12 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68546047056","LABEL_NAME":"AUSTEDO XR 6 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68546047156","LABEL_NAME":"AUSTEDO XR 12 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68546047256","LABEL_NAME":"AUSTEDO XR 24 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68546047356","LABEL_NAME":"AUSTEDO XR 30 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68546047456","LABEL_NAME":"AUSTEDO XR 36 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68546047556","LABEL_NAME":"AUSTEDO XR 42 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68546047656","LABEL_NAME":"AUSTEDO XR 48 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68546047729","LABEL_NAME":"AUSTEDO XR TITR(12-18-24-30MG)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68546047956","LABEL_NAME":"AUSTEDO XR 18 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68682001004","LABEL_NAME":"SODIUM SULFACETAMIDE 10% LOTN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68682037290","LABEL_NAME":"DILTIAZEM 24HR ER 420 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68682065020","LABEL_NAME":"DIAZEPAM 2.5MG RECTAL GEL(2PK)","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68682070430","LABEL_NAME":"DILTIAZEM 24H ER(LA) 120 MG TB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68682070530","LABEL_NAME":"DILTIAZEM 24H ER(LA) 180 MG TB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68682070630","LABEL_NAME":"DILTIAZEM 24H ER(LA) 240 MG TB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68682070730","LABEL_NAME":"DILTIAZEM 24H ER(LA) 300 MG TB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68682070830","LABEL_NAME":"DILTIAZEM 24H ER(LA) 360 MG TB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68682093890","LABEL_NAME":"TOLCAPONE 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68727015001","LABEL_NAME":"XYWAV 0.5 GM/ML ORAL SOLUTION","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68727025001","LABEL_NAME":"MODEYSO 125 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68875010101","LABEL_NAME":"GATTEX 5 MG VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68875010201","LABEL_NAME":"GATTEX 5 MG 30-VIAL KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68875010301","LABEL_NAME":"GATTEX 5 MG ONE-VIAL KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68968051408","LABEL_NAME":"COMBIPATCH 0.05-0.14 MG PTCH","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68968052508","LABEL_NAME":"COMBIPATCH 0.05-0.25 MG PTCH","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68974020030","LABEL_NAME":"FILSPARI 200 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68974040030","LABEL_NAME":"FILSPARI 400 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68999018905","LABEL_NAME":"ALBUTEROL 2 MG/5 ML SYRUP CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68999018920","LABEL_NAME":"ALBUTEROL 8 MG/20 ML SYRUP CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68999025024","LABEL_NAME":"PREDNISOLONE 15MG/5ML SOLN CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68999054010","LABEL_NAME":"CITALOPRAM HBR 20 MG/10 ML CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68999070624","LABEL_NAME":"LAMIVUDINE 300 MG/30ML SOL CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68999072910","LABEL_NAME":"ESCITALOPRAM 10 MG/10 ML CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68999076724","LABEL_NAME":"DIAZEPAM 5 MG/5 ML ORAL CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68999080305","LABEL_NAME":"ACYCLOVIR 200 MG/5 ML SUSP CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"68999080320","LABEL_NAME":"ACYCLOVIR 800 MG/20ML SUSP CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"69097000467","LABEL_NAME":"HYDROCORTISONE SS 100 MG VIAL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"69097042967","LABEL_NAME":"NYPOZI 480 MCG/0.8 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"69097043067","LABEL_NAME":"NYPOZI 300 MCG/0.5 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"69097090667","LABEL_NAME":"LANREOTIDE 120 MG/0.5 ML SYRNG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"69101060008","LABEL_NAME":"HYDROCODONE-ACETAMIN 10-325/15","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"69102015006","LABEL_NAME":"SUBVENITE 150 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"69102030101","LABEL_NAME":"SUBVENITE 25 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"69102031901","LABEL_NAME":"SUBVENITE 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"69102032001","LABEL_NAME":"SUBVENITE 200 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"69230014620","LABEL_NAME":"IBUPROFEN 200 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"69238199301","LABEL_NAME":"ASA-BUTALB-CAFF-COD #3 CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"69238208806","LABEL_NAME":"BEXAROTENE 1% GEL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"69292072225","LABEL_NAME":"FLURBIPROFEN 0.03% EYE DROP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"69315031228","LABEL_NAME":"PROCTO-MED HC 2.5% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"69367025130","LABEL_NAME":"WESNATAL DHA COMPLETE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"69367026701","LABEL_NAME":"WESTAB PLUS TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"69367030401","LABEL_NAME":"MIGLITOL 50 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"69367030951","LABEL_NAME":"SODIUM FLUORIDE 5000 PLUS CRM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"69367031801","LABEL_NAME":"SODIUM FLUORIDE-POTASSIUM NITR","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"69374030920","LABEL_NAME":"ALBUTEROL 100 MG/20 ML SOLN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"69374033005","LABEL_NAME":"ALBUTEROL 25 MG/5 ML SOLUTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"69448002563","LABEL_NAME":"UDENYCA 6 MG/0.6 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"69448002663","LABEL_NAME":"UDENYCA 6 MG/0.6 ML AUTOINJECT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"69448002763","LABEL_NAME":"UDENYCA 6 MG/0.6 ML ONBODY","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"69452039588","LABEL_NAME":"HYDROXYZINE 10 MG/5 ML SOLN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"69536028110","LABEL_NAME":"ST. JOSEPH ASPIRIN 81 MG CHEW","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"69616021103","LABEL_NAME":"FIRDAPSE 10 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"69616026438","LABEL_NAME":"AGAMREE 40 MG/ML SUSPENSION","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"69639010101","LABEL_NAME":"AKYNZEO 300-0.5 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"69639012001","LABEL_NAME":"VALCHLOR 0.016% GEL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"69668043301","LABEL_NAME":"MONDOXYNE NL 100 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"69794005050","LABEL_NAME":"DOJOLVI LIQUID","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"69842008805","LABEL_NAME":"CVS ADAPALENE 0.1% GEL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"69842008952","LABEL_NAME":"CVS WOMEN'S GENTLE LAX EC 5 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"69842031278","LABEL_NAME":"CVS 8HR MUSCLE ACHES ER 650 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"69842032967","LABEL_NAME":"CVS IBUPROFEN 100 MG CHEW TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"69842033726","LABEL_NAME":"CVS CHILD ALLERGY 5 MG/5 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"69842061802","LABEL_NAME":"CVS PINWORM TREATMENT 50 MG/ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"69842081926","LABEL_NAME":"CVS TUSSIN DM 400-20 MG/20 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"69842087651","LABEL_NAME":"CVS ACETAMINOPHEN 325 MG GELCP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"69842087808","LABEL_NAME":"CVS ACETAMINOPHEN 500 MG/15 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"69842090001","LABEL_NAME":"CVS FLUTICASONE PROP 50 MCG SP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"69842093108","LABEL_NAME":"CVS ACETAMINOPHEN 500 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"69842096801","LABEL_NAME":"CVS ACETAMINOPHEN 325 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"69848000609","LABEL_NAME":"ALLERGY 10 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70000000901","LABEL_NAME":"MICONAZOLE-7 CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70000005301","LABEL_NAME":"EYE ALLERGY ITCH RLF 0.2% DROP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70000012501","LABEL_NAME":"CHILD ALLERGY 5 MG/5 ML SOLN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70000030901","LABEL_NAME":"CHILD ACETAMINOPHEN 160 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70000032301","LABEL_NAME":"ANTIFUNGAL 2% POWDER","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70000047301","LABEL_NAME":"CHILD ALLERGY RELIEF 5 MG/5 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70000062801","LABEL_NAME":"TUSSIN DM 400-20 MG/20 ML LIQ","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70000063101","LABEL_NAME":"CHILDREN'S COLD-COUGH LIQUID","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70069003001","LABEL_NAME":"HALOPERIDOL DEC 50 MG/ML AMPUL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70069003101","LABEL_NAME":"HALOPERIDOL DEC 100 MG/ML AMP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70069058301","LABEL_NAME":"ATROPINE 1% EYE DROP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70121156801","LABEL_NAME":"RELEUKO 300 MCG/0.5 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70121157001","LABEL_NAME":"RELEUKO 480 MCG/0.8 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70121162701","LABEL_NAME":"FYLNETRA 6 MG/0.6 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70127010001","LABEL_NAME":"EPIDIOLEX 100 MG/ML SOLUTION","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70127010010","LABEL_NAME":"EPIDIOLEX 100 MG/ML SOLN PACK","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70255001002","LABEL_NAME":"MEKTOVI 15 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70255002501","LABEL_NAME":"BRAFTOVI 75 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70309008002","LABEL_NAME":"PINAWAY 50 MG/ML SUSPENSION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70370106001","LABEL_NAME":"INGREZZA 60 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70370108001","LABEL_NAME":"INGREZZA 80 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70370204001","LABEL_NAME":"INGREZZA 40 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70370204806","LABEL_NAME":"INGREZZA INITIATION PK(TARDIV)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70370404001","LABEL_NAME":"INGREZZA 40 MG SPRINKLE CAP","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70370406001","LABEL_NAME":"INGREZZA 60 MG SPRINKLE CAP","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70370408001","LABEL_NAME":"INGREZZA 80 MG SPRINKLE CAP","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70370502501","LABEL_NAME":"CRENESSITY 25 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70370505001","LABEL_NAME":"CRENESSITY 50 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70370510001","LABEL_NAME":"CRENESSITY 100 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70370525001","LABEL_NAME":"CRENESSITY 50 MG/ML SOLUTION","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70393000811","LABEL_NAME":"CARETOUCH TWIST 28G LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70393000812","LABEL_NAME":"CARETOUCH TWIST 30G LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70393013101","LABEL_NAME":"CARETOUCH HYPODERMIC 18G 1.5\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70393013401","LABEL_NAME":"CARETOUCH HYPODERMIC 20G 1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70393014001","LABEL_NAME":"CARETOUCH HYPODERMIC 22G 1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70393014201","LABEL_NAME":"CARETOUCH HYPODERMIC 23G 1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70393014301","LABEL_NAME":"CARETOUCH HYPODERMIC 23G 1.5\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70393014401","LABEL_NAME":"CARETOUCH HYPODERMIC 25G 5/8\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70393014501","LABEL_NAME":"CARETOUCH HYPODERMIC 25G 1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70393014601","LABEL_NAME":"CARETOUCH HYPODERMIC 25G 1.5\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70393014701","LABEL_NAME":"CARETOUCH HYPO NEEDLE 26G 1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70393015201","LABEL_NAME":"CARETOUCH TWIST 33G LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70393016901","LABEL_NAME":"CARETOUCH 26G SAFETY LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70393017101","LABEL_NAME":"CARETOUCH 28G SAFETY LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70393020100","LABEL_NAME":"CARETOUCH LANCING DEVICE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70393029601","LABEL_NAME":"CARETOUCH SYR 1 ML 28GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70393029901","LABEL_NAME":"CARETOUCH SYR 1 ML 29GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70393030101","LABEL_NAME":"CARETOUCH SYR 0.5 ML 30GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70393030201","LABEL_NAME":"CARETOUCH SYR 1 ML 30GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70393030901","LABEL_NAME":"CARETOUCH SYR 0.3 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70393031001","LABEL_NAME":"CARETOUCH SYR 0.5 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70393031101","LABEL_NAME":"CARETOUCH SYR 1 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70393050101","LABEL_NAME":"CARETOUCH LUER SLIP 1 ML SYRN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70393050201","LABEL_NAME":"CARETOUCH LUER SLIP 3 ML SYRN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70393050301","LABEL_NAME":"CARETOUCH LUER SLIP 5 ML SYR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70393050401","LABEL_NAME":"CARETOUCH LUER SLIP 10 ML SYR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70393051701","LABEL_NAME":"CARETOUCH LUER LOCK 1 ML SYR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70393051801","LABEL_NAME":"CARETOUCH LUER LOCK 3 ML SYR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70393051901","LABEL_NAME":"CARETOUCH LUER LOCK 5 ML SYR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70393055501","LABEL_NAME":"CARETOUCH LL SYR 3 ML 22G 1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70393055601","LABEL_NAME":"CARETOUCH LL SYR 3 ML 22G 1.5\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70393055701","LABEL_NAME":"CARETOUCH LL SYR 3 ML 23G 1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70393055901","LABEL_NAME":"CARETOUCH LL SYR 3 ML 23G 1.5\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70393056001","LABEL_NAME":"CARETOUCH LL SYR 3 ML 25G 5/8\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70393056101","LABEL_NAME":"CARETOUCH LL SYR 3 ML 25G 1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70393056201","LABEL_NAME":"CARETOUCH LL SYR 3 ML 25G 1.5\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70437024018","LABEL_NAME":"NERLYNX 40 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70461002503","LABEL_NAME":"FLUAD 2025-2026 SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70461055510","LABEL_NAME":"FLUCELVAX 2025-2026 VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70461065503","LABEL_NAME":"FLUCELVAX 2025-2026 SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70461070003","LABEL_NAME":"AUDENZ SYRINGE (STOCKPILE)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70461080040","LABEL_NAME":"AUDENZ 5 ML VIAL (STOCKPILE)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70505022060","LABEL_NAME":"NITISINONE 20 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70510232101","LABEL_NAME":"RADICAVA ORS STARTER KIT SUSP","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70510232102","LABEL_NAME":"RADICAVA ORS STARTER KIT SUSP","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70510232201","LABEL_NAME":"RADICAVA ORS 105 MG/5 ML SUSP","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70564045615","LABEL_NAME":"GELCLAIR ORAL GEL PACKET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70677003101","LABEL_NAME":"SM NICOTINE 14 MG/24HR PATCH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70677003201","LABEL_NAME":"SM NICOTINE 21 MG/24HR PATCH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70677015001","LABEL_NAME":"SM CHILD IBUPROFEN 100 MG/5 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70677100001","LABEL_NAME":"FT ANTIFUNGAL 2% TOPICAL CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70677100701","LABEL_NAME":"FT AD ALLERGY (CETRZN) 10MG TB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70677101501","LABEL_NAME":"FT ALLERGY (DIPHEN) 25 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70677102101","LABEL_NAME":"FT ALLERGY RELIEF 50 MCG SPRAY","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70677102201","LABEL_NAME":"FT ALLERGY (LORAT) 10 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70677102301","LABEL_NAME":"FT 24H NASAL ALLERGY 55MCG SPR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70677104201","LABEL_NAME":"FT CHILD ALLERGY RLF 1 MG/ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70677105301","LABEL_NAME":"FT AD ALLERGY (LORAT) 10 MG TB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70677105401","LABEL_NAME":"FT CHEST CONGEST 400 MG CAPLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70677105701","LABEL_NAME":"FT CHILD ALLERGY 5 MG/5 ML SOL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70677106801","LABEL_NAME":"FT CLEARLAX POWDER","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70677106802","LABEL_NAME":"FT CLEARLAX POWDER","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70677107201","LABEL_NAME":"FT MILK OF MAGNESIA SUSPENSION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70677108601","LABEL_NAME":"FT LAXATIVE EC 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70677111101","LABEL_NAME":"FT MAGNESIUM CITRATE SOLUTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70677111301","LABEL_NAME":"FT IBUPROFEN 200 MG MINI SFGL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70677111401","LABEL_NAME":"FT IBUPROFEN 200 MG SOFTGEL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70677111501","LABEL_NAME":"FT CHILD IBUPROFEN 100 MG/5 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70677111901","LABEL_NAME":"FT PAIN RELIEF 325 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70677112001","LABEL_NAME":"FT PAIN RELIEF 500 MG GELCAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70677112101","LABEL_NAME":"FT ASPIRIN EC 81 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70677112301","LABEL_NAME":"FT 8 HOUR PAIN RLF ER 650 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70677112401","LABEL_NAME":"FT PAIN RELIEF 500 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70677112701","LABEL_NAME":"FT CHILD ACETAMINOPHEN 160 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70677112901","LABEL_NAME":"FT SLEEP AID 25 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70677113201","LABEL_NAME":"FT IBUPROFEN 200 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70677113401","LABEL_NAME":"FT ASPIRIN 81 MG CHEWABLE TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70677113601","LABEL_NAME":"FT IBUPROFEN 200 MG CAPLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70677113801","LABEL_NAME":"FT PAIN RELIEVER 500 MG CAPLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70677114201","LABEL_NAME":"FT CHILD PAIN-FEVER 160 MG/5ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70677114401","LABEL_NAME":"FT INF IBUPROFEN 50 MG/1.25 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70677114501","LABEL_NAME":"FT IBUPROFEN IB 100 MG CHEW TB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70677115501","LABEL_NAME":"FT EYE ALLERGY ITCH RLF 0.2%","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70677116401","LABEL_NAME":"FT NICOTINE 2 MG CHEWING GUM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70677116501","LABEL_NAME":"FT NICOTINE 4 MG CHEWING GUM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70677117201","LABEL_NAME":"FT NICOTINE 2 MG MINI LOZENGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70677117301","LABEL_NAME":"FT NICOTINE 4 MG MINI LOZENGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70677117401","LABEL_NAME":"FT NICOTINE 2 MG LOZENGE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70677117501","LABEL_NAME":"FT NICOTINE 4 MG LOZENGE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70677117701","LABEL_NAME":"FT NICOTINE 4 MG LOZENGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70677117801","LABEL_NAME":"FT NICOTINE 2 MG MINI LOZENGE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70677118001","LABEL_NAME":"FT NICOTINE 7 MG/24HR PATCH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70677118101","LABEL_NAME":"FT NICOTINE 14 MG/24HR PATCH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70677118201","LABEL_NAME":"FT NICOTINE 21 MG/24HR PATCH","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70677122201","LABEL_NAME":"FT MICONAZOLE 7 CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70677122301","LABEL_NAME":"FT MICONAZOLE 3 COMBO PACK","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70677122601","LABEL_NAME":"FT MICONAZOLE 3 COMBO PACK","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70677123101","LABEL_NAME":"FT CLOTRIMAZOLE-3 2% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70677123601","LABEL_NAME":"FT CHILD ALL DAY ALLER 1 MG/ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70677124101","LABEL_NAME":"FT ALLERGY (CETRZN) 10 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70677124201","LABEL_NAME":"FT PAIN RELIEF 500 MG CAPLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70677125301","LABEL_NAME":"FT INFANT PAIN-FEVER 160 MG/5","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70677126201","LABEL_NAME":"FT CLOTRIMAZOLE 1% VAG CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70677126801","LABEL_NAME":"FT CHILD ALLERGY 12.5 MG/5 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70677128201","LABEL_NAME":"FT IBUPROFEN 200 MG LIQUID GEL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"70700010184","LABEL_NAME":"NORETH-EE-FE 1-0.02(24)-75 CHW","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70700011384","LABEL_NAME":"ISIBLOOM 28 DAY TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70700011484","LABEL_NAME":"LORYNA 3 MG-0.02 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70700011584","LABEL_NAME":"SYEDA 28 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70700011684","LABEL_NAME":"ALTAVERA-28 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70700011884","LABEL_NAME":"VIENVA-28 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70700011984","LABEL_NAME":"ESTARYLLA 0.25-0.035 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70700012084","LABEL_NAME":"TRI-LO-ESTARYLLA TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70700012184","LABEL_NAME":"TRI-ESTARYLLA TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70700012284","LABEL_NAME":"VOLNEA 0.15-0.02-0.01 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70700012387","LABEL_NAME":"JAIMIESS 0.15-0.03-0.01 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70700012487","LABEL_NAME":"LOJAIMIESS 0.1-0.02-0.01 TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70700015611","LABEL_NAME":"ENILLORING VAGINAL RING","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70700020887","LABEL_NAME":"INTROVALE 0.15-0.03 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70700030384","LABEL_NAME":"ABIGALE LO 0.5-0.1 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70700030484","LABEL_NAME":"VALTYA 1 MG-35 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70700030584","LABEL_NAME":"VALTYA 1 MG-50 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70700030684","LABEL_NAME":"GALBRIELA 0.8-0.025 MG CHEW TB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70700030784","LABEL_NAME":"FEIRZA 1 MG-20 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70700030884","LABEL_NAME":"XELRIA FE 0.4-0.035 MG CHEW TB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70700030984","LABEL_NAME":"FEIRZA 1.5 MG-30 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70700031084","LABEL_NAME":"XARAH FE 1 MG/20-30-35 MCG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70700031378","LABEL_NAME":"LUIZZA 1 MG-20 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70700031478","LABEL_NAME":"LUIZZA 1.5 MG-30 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70700031684","LABEL_NAME":"ORQUIDEA 0.35 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70700031784","LABEL_NAME":"MELEYA 0.35 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70700032650","LABEL_NAME":"GALLIFREY 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70700033084","LABEL_NAME":"ABIGALE 1 MG-0.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70709000060","LABEL_NAME":"NITYR 10 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70709000260","LABEL_NAME":"NITYR 2 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70709000560","LABEL_NAME":"NITYR 5 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70709001301","LABEL_NAME":"SAJAZIR 30 MG/3 ML SYRINGE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70709011260","LABEL_NAME":"HARLIKU 2 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70709012130","LABEL_NAME":"VENXXIVA DR 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70709012390","LABEL_NAME":"VENXXIVA DR 300 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70710119001","LABEL_NAME":"NORELGESTROM-EE 150-35 MCG/DAY","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70710146201","LABEL_NAME":"HALOPERIDOL DEC 250 MG/5 ML VL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70710174901","LABEL_NAME":"JAYTHARI 6 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70710175003","LABEL_NAME":"JAYTHARI 18 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70710175103","LABEL_NAME":"JAYTHARI 30 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70710175203","LABEL_NAME":"JAYTHARI 36 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70710213103","LABEL_NAME":"JAYTHARI 22.75 MG/ML ORAL SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70720010102","LABEL_NAME":"VARUBI 180 MG DOSE(2X 90MG TB)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70720012585","LABEL_NAME":"XERMELO 250 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70720095036","LABEL_NAME":"ZOLADEX 3.6 MG IMPLANT SYRN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70720095130","LABEL_NAME":"ZOLADEX 10.8 MG IMPLANT SYRN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70748023806","LABEL_NAME":"TOLVAPTAN 15 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70748023906","LABEL_NAME":"TOLVAPTAN 30 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70748024011","LABEL_NAME":"TOLVAPTAN 15 MG-15 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70748024111","LABEL_NAME":"TOLVAPTAN 30 MG-15 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70748024211","LABEL_NAME":"TOLVAPTAN 45 MG-15 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70748024311","LABEL_NAME":"TOLVAPTAN 60 MG-30 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70748024411","LABEL_NAME":"TOLVAPTAN 90 MG-30 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70752012905","LABEL_NAME":"TRIAMCINOLONE 0.025% LOTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70954014010","LABEL_NAME":"LEVOCARNITINE SF 1 G/10 ML SOL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70954022810","LABEL_NAME":"METHSUXIMIDE 300 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70954041710","LABEL_NAME":"L-GLUTAMINE 5 GRAM POWDER PKT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"70954054110","LABEL_NAME":"TRIMETHOPRIM 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"71085008130","LABEL_NAME":"CLEMSZA 2.68 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"71085008230","LABEL_NAME":"LURBIRO 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"71121051070","LABEL_NAME":"CUTTER ALL FAMILY 7% SPRAY","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"71121054055","LABEL_NAME":"CUTTER ALL FAMILY 7% SPRAY","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"71121095838","LABEL_NAME":"CUTTER ALL FAMILY 7.15% WIPE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"71121095917","LABEL_NAME":"CUTTER NATURAL REPELLENT SPRAY","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"71121096014","LABEL_NAME":"CUTTER LEMON EUCALYPTUS SPRAY","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"71121096058","LABEL_NAME":"CUTTER DRY 10% SPRAY","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"71121096172","LABEL_NAME":"CUTTER SKINSATIONS 7% SPRAY","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"71121096179","LABEL_NAME":"CUTTER NATURAL REPELLENT2 SPRY","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"71121096248","LABEL_NAME":"CUTTER BACKWOODS DRY 25% SPRAY","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"71121096253","LABEL_NAME":"CUTTER SPORT 15% SPRAY","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"71121096280","LABEL_NAME":"CUTTER BACKWOODS 25% SPRAY","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"71121096284","LABEL_NAME":"CUTTER BACKWOODS 25% SPRAY","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"71143037501","LABEL_NAME":"XHANCE 93 MCG NASAL SPRAY","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"71269004010","LABEL_NAME":"TUXARIN ER 8-54.3 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"71274017060","LABEL_NAME":"JOENJA 70 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"71274035001","LABEL_NAME":"RUCONEST 2,100 UNIT VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"71288040681","LABEL_NAME":"HEPARIN SOD 5,000 UNIT/ML SYRG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"71321050010","LABEL_NAME":"THEOPHYLLINE ER 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"71321050110","LABEL_NAME":"THEOPHYLLINE ER 200 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"71332000101","LABEL_NAME":"TAVALISSE 100 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"71332000201","LABEL_NAME":"TAVALISSE 150 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"71332000501","LABEL_NAME":"REZLIDHIA 150 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"71332000660","LABEL_NAME":"GAVRETO 100 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"71334020505","LABEL_NAME":"PYRUKYND 5 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"71334021014","LABEL_NAME":"PYRUKYND 20 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"71334021514","LABEL_NAME":"PYRUKYND 50 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"71334022011","LABEL_NAME":"PYRUKYND 5 MG TAPER PACK","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"71334022512","LABEL_NAME":"PYRUKYND 20-5 MG TAPER PACK","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"71334023013","LABEL_NAME":"PYRUKYND 50-20 MG TAPER PACK","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"71336100201","LABEL_NAME":"OXLUMO 94.5 MG/0.5 ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"71369001030","LABEL_NAME":"DOPTELET SPRINKLE 10 MG CAP","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"71369002010","LABEL_NAME":"DOPTELET (10 TAB PK) 20 MG TAB","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"71369002015","LABEL_NAME":"DOPTELET (15 TAB PK) 20 MG TAB","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"71369002030","LABEL_NAME":"DOPTELET (30 TAB PK) 20 MG TAB","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"71399002304","LABEL_NAME":"MAXALLERGY KIDS 12.5 MG/5 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"71399005101","LABEL_NAME":"ONELAX MAGNESIUM CITRATE SOLN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"71399012001","LABEL_NAME":"HYDROCORTISONE 1% LOTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"71399016004","LABEL_NAME":"CHILD PAIN RLF 160 MG/5 ML ELX","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"71399100404","LABEL_NAME":"TUSSIN DM 20-200 MG/10 ML LIQ","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"71399740105","LABEL_NAME":"PEDIATRIC D-VITE 10 MCG/ML LIQ","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"71558059028","LABEL_NAME":"ARIKAYCE 590 MG/8.4 ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"71656001650","LABEL_NAME":"LEVOCARNITINE 500 MG/5 ML CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"71656001651","LABEL_NAME":"LEVOCARNITINE 1 G/10 ML CUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"71699002530","LABEL_NAME":"XCOPRI 25 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"71699005030","LABEL_NAME":"XCOPRI 50 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"71699010030","LABEL_NAME":"XCOPRI 100 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"71699010356","LABEL_NAME":"XCOPRI 350 MG DAILY DOSE PACK","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"71699010456","LABEL_NAME":"XCOPRI 250 MG DAILY DOSE PACK","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"71699015030","LABEL_NAME":"XCOPRI 150 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"71699020030","LABEL_NAME":"XCOPRI 200 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"71699020128","LABEL_NAME":"XCOPRI 12.5-25 MG TITRATION PK","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"71699020228","LABEL_NAME":"XCOPRI 50-100 MG TITRATION PAK","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"71699020328","LABEL_NAME":"XCOPRI 150-200 MG TITRATION PK","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"71741002030","LABEL_NAME":"NIACIN 500 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"71770020010","LABEL_NAME":"PHEBURANE PELLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"71779062301","LABEL_NAME":"AVMAPKI-FAKZYNJA CO-PACK","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"71837584301","LABEL_NAME":"LEUKINE 250 MCG VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"71839011825","LABEL_NAME":"HEPARIN SOD 5,000 UNIT/0.5 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"71860010101","LABEL_NAME":"TRYNGOLZA 80 MG/0.8 ML AUTOINJ","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"71860010301","LABEL_NAME":"DAWNZERA 80 MG/0.8 ML PEN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"71881040012","LABEL_NAME":"VOWST CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"71904010001","LABEL_NAME":"GALAFOLD 123 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"71904030001","LABEL_NAME":"OPFOLDA 65 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"71981002007","LABEL_NAME":"OXERVATE 0.002% EYE DROP","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72064011030","LABEL_NAME":"AYVAKIT 100 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72064012030","LABEL_NAME":"AYVAKIT 200 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72064012530","LABEL_NAME":"AYVAKIT 25 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72064013030","LABEL_NAME":"AYVAKIT 300 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72064015030","LABEL_NAME":"AYVAKIT 50 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72065000301","LABEL_NAME":"RECORLEV 150 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72065012011","LABEL_NAME":"GVOKE HYPOPEN 1PK 0.5MG/0.1 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72065012012","LABEL_NAME":"GVOKE HYPOPEN 2PK 0.5MG/0.1 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72065012111","LABEL_NAME":"GVOKE HYPOPEN 1-PK 1 MG/0.2 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72065012112","LABEL_NAME":"GVOKE HYPOPEN 2-PK 1 MG/0.2 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72065013111","LABEL_NAME":"GVOKE PFS 1-PK 1 MG/0.2 ML SYR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72065013112","LABEL_NAME":"GVOKE PFS 2-PK 1 MG/0.2 ML SYR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72065014011","LABEL_NAME":"GVOKE 1 MG/0.2 ML KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72065014111","LABEL_NAME":"GVOKE 1 MG/0.2 ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72140003101","LABEL_NAME":"AQUAPHOR ITCH RELIEF 1% OINT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"72187010103","LABEL_NAME":"ORSERDU 86 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72187010203","LABEL_NAME":"ORSERDU 345 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72205007179","LABEL_NAME":"PERAMPANEL 0.5 MG/ML ORAL SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72217000201","LABEL_NAME":"ULTRA-CARE 30G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"72217000701","LABEL_NAME":"ULTRACARE INS 0.5 ML 30GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72217000702","LABEL_NAME":"ULTRACARE INS 1 ML 30GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72217000703","LABEL_NAME":"ULTRACARE INS 0.3 ML 30GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72217000704","LABEL_NAME":"ULTRACARE INS 0.5 ML 30GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72217000705","LABEL_NAME":"ULTRACARE INS 1 ML 30G X 5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72217000706","LABEL_NAME":"ULTRACARE INS 0.3 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72217000707","LABEL_NAME":"ULTRACARE INS 0.5 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72217000708","LABEL_NAME":"ULTRACARE INS 1 ML 31G X 5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72217003901","LABEL_NAME":"PROCARE SPACER WITH ADULT MASK","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72217003902","LABEL_NAME":"PROCARE SPACER WITH CHILD MASK","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72237010103","LABEL_NAME":"XPOVIO 60 MG TWICE WEEKLY DOSE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72237010104","LABEL_NAME":"XPOVIO 80 MG TWICE WEEKLY DOSE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72237010202","LABEL_NAME":"XPOVIO 80 MG ONCE WEEKLY DOSE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72237010206","LABEL_NAME":"XPOVIO 40 MG TWICE WEEKLY DOSE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72237010305","LABEL_NAME":"XPOVIO 100 MG ONCE WEEKLY DOSE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72237010401","LABEL_NAME":"XPOVIO 60 MG ONCE WEEKLY DOSE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72237010501","LABEL_NAME":"XPOVIO 80 MG ONCE WEEKLY DOSE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72237010601","LABEL_NAME":"XPOVIO 40 MG ONCE WEEKLY DOSE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72252050505","LABEL_NAME":"VALTOCO 5 MG NASAL SPRAY","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72252051005","LABEL_NAME":"VALTOCO 10 MG NASAL SPRAY","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72252051510","LABEL_NAME":"VALTOCO 15 MG NASAL SPRAY","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72252052010","LABEL_NAME":"VALTOCO 20 MG NASAL SPRAY","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72305002530","LABEL_NAME":"EUTHYROX 25 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72305005030","LABEL_NAME":"EUTHYROX 50 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72305007530","LABEL_NAME":"EUTHYROX 75 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72305008830","LABEL_NAME":"EUTHYROX 88 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72305011230","LABEL_NAME":"EUTHYROX 112 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72305012530","LABEL_NAME":"EUTHYROX 125 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72305013730","LABEL_NAME":"EUTHYROX 137 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72305017530","LABEL_NAME":"EUTHYROX 175 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72426011803","LABEL_NAME":"NEXLETOL 180 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72426081803","LABEL_NAME":"NEXLIZET 180-10 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72482010012","LABEL_NAME":"VONJO 100 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72495040128","LABEL_NAME":"INTRAROSA 6.5 MG VAG INSERT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72507080004","LABEL_NAME":"FORZINITY 280 MG/3.5 ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72511039301","LABEL_NAME":"REPATHA 140 MG/ML SURECLICK","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72511050101","LABEL_NAME":"REPATHA 140 MG/ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72511077001","LABEL_NAME":"REPATHA 420 MG/3.5ML PUSHTRONX","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72526010211","LABEL_NAME":"RYKINDO ER 25 MG VIAL KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72526010311","LABEL_NAME":"RYKINDO ER 37.5 MG VIAL KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72526010411","LABEL_NAME":"RYKINDO ER 50 MG VIAL KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72526010511","LABEL_NAME":"ERZOFRI 39 MG/0.25 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72526010611","LABEL_NAME":"ERZOFRI 78 MG/0.5 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72526010711","LABEL_NAME":"ERZOFRI 117 MG/0.75 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72526010811","LABEL_NAME":"ERZOFRI 156 MG/ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72526010911","LABEL_NAME":"ERZOFRI 234 MG/1.5 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72526011011","LABEL_NAME":"ERZOFRI 351 MG/2.25 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72526020201","LABEL_NAME":"RYKINDO ER 25 MG VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72526020301","LABEL_NAME":"RYKINDO ER 37.5 MG VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72526020401","LABEL_NAME":"RYKINDO ER 50 MG VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72542012401","LABEL_NAME":"MIPLYFFA 124 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72542014701","LABEL_NAME":"MIPLYFFA 47 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72542016201","LABEL_NAME":"MIPLYFFA 62 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72542019301","LABEL_NAME":"MIPLYFFA 93 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72542020002","LABEL_NAME":"OLPRUVA 2 GRAM DOSE ENVELOPE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72542020009","LABEL_NAME":"OLPRUVA 2 GRAM DOSE KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72542030002","LABEL_NAME":"OLPRUVA 3 GRAM DOSE ENVELOPE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72542030009","LABEL_NAME":"OLPRUVA 3 GRAM DOSE KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72542040002","LABEL_NAME":"OLPRUVA 4 GRAM DOSE ENVELOPE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72542040018","LABEL_NAME":"OLPRUVA 4 GRAM DOSE KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72542050002","LABEL_NAME":"OLPRUVA 5 GRAM DOSE ENVELOPE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72542050018","LABEL_NAME":"OLPRUVA 5 GRAM DOSE KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72542060002","LABEL_NAME":"OLPRUVA 6 GRAM DOSE ENVELOPE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72542060018","LABEL_NAME":"OLPRUVA 6 GRAM DOSE KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72542066702","LABEL_NAME":"OLPRUVA 6.67 GM DOSE ENVELOPE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72542066718","LABEL_NAME":"OLPRUVA 6.67 GRAM DOSE KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72579012201","LABEL_NAME":"BRUKINSA 160 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72606002501","LABEL_NAME":"ZYMFENTRA 120 MG/ML PEN KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72606002510","LABEL_NAME":"ZYMFENTRA 120 MG/ML SYRINGE KT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72607010000","LABEL_NAME":"TAZVERIK 200 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72618300002","LABEL_NAME":"NURTEC ODT 75 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72626260101","LABEL_NAME":"LEDIPASVIR-SOFOSBUVIR 90-400MG","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72626270101","LABEL_NAME":"SOFOSBUVIR-VELPATASVIR 400-100","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72627210001","LABEL_NAME":"TESTOSTERONE CYP 6,000 MG/30ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72627210003","LABEL_NAME":"TESTOSTERONE CYP 1,000 MG/5 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72627210006","LABEL_NAME":"TESTOSTERONE CYP 500 MG/2.5 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72627230001","LABEL_NAME":"CHORIONIC GONAD 6,000 UNIT VL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72657010812","LABEL_NAME":"SHEWISE 1.5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"72694061760","LABEL_NAME":"TIBSOVO 250 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72694072840","LABEL_NAME":"VORANIGO 40 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72694087910","LABEL_NAME":"VORANIGO 10 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72769010101","LABEL_NAME":"ORLADEYO 150 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72769010201","LABEL_NAME":"ORLADEYO 110 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72829001001","LABEL_NAME":"IMCIVREE 10 MG/ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72888014222","LABEL_NAME":"LEVOFLOXACIN 0.5% EYE DROP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72888020766","LABEL_NAME":"IVERMECTIN 6 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72893001602","LABEL_NAME":"RYZNEUTA 20 MG/ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72960011201","LABEL_NAME":"DAXXIFY 100 UNIT VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72964001101","LABEL_NAME":"YUTREPIA 26.5 MCG INHAL CAP","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72964001201","LABEL_NAME":"YUTREPIA 53 MCG INHAL CAP","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72964001301","LABEL_NAME":"YUTREPIA 79.5 MCG INHAL CAP","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72964001401","LABEL_NAME":"YUTREPIA 106 MCG INHAL CAP","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72974012001","LABEL_NAME":"ORGOVYX 120 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"72974041501","LABEL_NAME":"MYFEMBREE 40 MG-1 MG-0.5 MG TB","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"73116021528","LABEL_NAME":"COPIKTRA 15 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"73116022528","LABEL_NAME":"COPIKTRA 25 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"73154005060","LABEL_NAME":"IBSRELA 50 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"73177011415","LABEL_NAME":"DESMOPRESSIN 1.5 MG/ML SPRAY","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"73177014632","LABEL_NAME":"ALBUTEROL 15 MG/3 ML SOLUTION","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"73207010130","LABEL_NAME":"QINLOCK 50 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"73207030240","LABEL_NAME":"ROMVIMZA 14 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"73207030340","LABEL_NAME":"ROMVIMZA 20 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"73207030440","LABEL_NAME":"ROMVIMZA 30 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"73289007001","LABEL_NAME":"ZELVYSIA 100 MG POWDER PACKET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"73289007101","LABEL_NAME":"ZELVYSIA 500 MG POWDER PACKET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"73289008901","LABEL_NAME":"PYQUVI 22.75 MG/ML ORAL SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"73302045601","LABEL_NAME":"ELLA 30 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"73317461001","LABEL_NAME":"COMFORT TOUCH ULT THIN 31G LAN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"73317468201","LABEL_NAME":"COMFORTTOUCH PLUS SAF 30G LANC","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"73362000301","LABEL_NAME":"SKYTROFA 3 MG CARTRIDGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"73362000401","LABEL_NAME":"SKYTROFA 3.6 MG CARTRIDGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"73362000501","LABEL_NAME":"SKYTROFA 4.3 MG CARTRIDGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"73362000601","LABEL_NAME":"SKYTROFA 5.2 MG CARTRIDGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"73362000701","LABEL_NAME":"SKYTROFA 6.3 MG CARTRIDGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"73362000801","LABEL_NAME":"SKYTROFA 7.6 MG CARTRIDGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"73362000901","LABEL_NAME":"SKYTROFA 9.1 MG CARTRIDGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"73362001001","LABEL_NAME":"SKYTROFA 11 MG CARTRIDGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"73362001101","LABEL_NAME":"SKYTROFA 13.3 MG CARTRIDGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"73362001201","LABEL_NAME":"SKYTROFA 0.7 MG CARTRIDGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"73362001301","LABEL_NAME":"SKYTROFA 1.4 MG CARTRIDGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"73362001401","LABEL_NAME":"SKYTROFA 1.8 MG CARTRIDGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"73362001501","LABEL_NAME":"SKYTROFA 2.1 MG CARTRIDGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"73362001601","LABEL_NAME":"SKYTROFA 2.5 MG CARTRIDGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"73362010001","LABEL_NAME":"YORVIPATH 168 MCG/0.56 ML PEN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"73362010101","LABEL_NAME":"YORVIPATH 294 MCG/0.98 ML PEN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"73362010201","LABEL_NAME":"YORVIPATH 420 MCG/1.4 ML PEN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"73475122101","LABEL_NAME":"VYVGART HYTRULO 1,000MG-10,000","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"73515012330","LABEL_NAME":"CYCLOSET 0.8 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"73536050001","LABEL_NAME":"BESREMI 500 MCG/ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"73555050000","LABEL_NAME":"REVUFORJ 25 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"73555050100","LABEL_NAME":"REVUFORJ 110 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"73555050200","LABEL_NAME":"REVUFORJ 160 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"73556016801","LABEL_NAME":"TAVNEOS 10 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"73562010410","LABEL_NAME":"VIOKACE 10,440-39,150 UNIT TAB","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"73562011001","LABEL_NAME":"ZENPEP DR 10,000 UNIT CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"73562011101","LABEL_NAME":"ZENPEP DR 15,000 UNIT CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"73562011201","LABEL_NAME":"ZENPEP DR 20,000 UNIT CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"73562011301","LABEL_NAME":"ZENPEP DR 3,000 UNIT CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"73562011401","LABEL_NAME":"ZENPEP DR 40,000 UNIT CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"73562011501","LABEL_NAME":"ZENPEP DR 5,000 UNIT CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"73562011601","LABEL_NAME":"ZENPEP DR 25,000 UNIT CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"73562011701","LABEL_NAME":"ZENPEP DR 60,000 UNIT CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"73562020810","LABEL_NAME":"VIOKACE 20,880-78,300 UNITS TB","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"73604091404","LABEL_NAME":"ARCALYST 220 MG VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"73606001001","LABEL_NAME":"EMPAVELI 1,080 MG/20 ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"73625011111","LABEL_NAME":"CAMZYOS 2.5 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"73625011211","LABEL_NAME":"CAMZYOS 5 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"73625011311","LABEL_NAME":"CAMZYOS 10 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"73625011411","LABEL_NAME":"CAMZYOS 15 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"73683010110","LABEL_NAME":"HYFTOR 0.2% GEL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"74676590200","LABEL_NAME":"TRELSTAR 3.75 MG VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"74676590400","LABEL_NAME":"TRELSTAR 11.25 MG VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"74676590600","LABEL_NAME":"TRELSTAR 22.5 MG VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"74695082318","LABEL_NAME":"VIVJOA 150 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"75537000951","LABEL_NAME":"ACCU-CHEK SAFE-T-PRO 23G LANCT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"75626000101","LABEL_NAME":"LUPKYNIS 7.9 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"75826016320","LABEL_NAME":"FLUORIDE 0.25 MG TABLET CHEW","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"75834020001","LABEL_NAME":"OFLOXACIN 300 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"75834020101","LABEL_NAME":"OFLOXACIN 400 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"75907004901","LABEL_NAME":"METHYLPHENIDATE ER(LA) 10MG CP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"75907005001","LABEL_NAME":"METHYLPHENIDATE ER(LA) 20MG CP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"75907005101","LABEL_NAME":"METHYLPHENIDATE ER(LA) 30MG CP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"75907005201","LABEL_NAME":"METHYLPHENIDATE ER(LA) 40MG CP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"75907007601","LABEL_NAME":"ERYTHROMYCIN DR 250 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"75907008128","LABEL_NAME":"MICROGESTIN FE 1.5-30 TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"75907008228","LABEL_NAME":"MICROGESTIN FE 1-20 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"75907008321","LABEL_NAME":"MICROGESTIN 21 1.5-30 TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"75907008421","LABEL_NAME":"MICROGESTIN 21 1-20 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"75907008528","LABEL_NAME":"NECON 0.5-35-28 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"75907008628","LABEL_NAME":"TILIA FE 28 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"75907008762","LABEL_NAME":"ZOVIA 1-35 TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"75907009128","LABEL_NAME":"AZURETTE 28 DAY TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"75987005006","LABEL_NAME":"RAVICTI 1.1 GRAM/ML LIQUID","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"75987010004","LABEL_NAME":"PROCYSBI DR 25 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"75987010108","LABEL_NAME":"PROCYSBI DR 75 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"75987011110","LABEL_NAME":"ACTIMMUNE 100 MCG/0.5 ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"75987014013","LABEL_NAME":"PROCYSBI DR 75 MG GRANULE PKT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"75987014513","LABEL_NAME":"PROCYSBI DR 300 MG GRANULE PKT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"76045010800","LABEL_NAME":"HEPARIN SOD 5,000 UNIT/ML SYRG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"76045073701","LABEL_NAME":"HALOPERIDOL LAC 5 MG/ML SYRING","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"76329366902","LABEL_NAME":"REXTOVY 4 MG NASAL SPRAY","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"76336008060","LABEL_NAME":"LYSODREN 500 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"76420037215","LABEL_NAME":"APHEN 325 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"76518005050","LABEL_NAME":"PEDIA D-VITE 400 UNIT/ML LIQ","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"76518006050","LABEL_NAME":"PEDIA IRON 15 MG/ML DROP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"76961010101","LABEL_NAME":"ROLVEDON 13.2 MG/0.6 ML SYRING","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"78206011101","LABEL_NAME":"ASMANEX HFA 50 MCG INHALER","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"78206011201","LABEL_NAME":"ASMANEX HFA 100 MCG INHALER","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"78206011301","LABEL_NAME":"ASMANEX HFA 200 MCG INHALER","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"78206011401","LABEL_NAME":"ASMANEX TWISTHALR 220 MCG #120","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"78206011402","LABEL_NAME":"ASMANEX TWISTHALER 220 MCG #60","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"78206011403","LABEL_NAME":"ASMANEX TWISTHALER 220 MCG #14","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"78206011404","LABEL_NAME":"ASMANEX TWISTHALER 220 MCG #30","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"78206011501","LABEL_NAME":"ASMANEX TWISTHALER 110 MCG #30","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"78206012501","LABEL_NAME":"DULERA 50 MCG-5 MCG INHALER","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"78206012601","LABEL_NAME":"DULERA 200 MCG-5 MCG INHALER","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"78206012701","LABEL_NAME":"DULERA 100 MCG-5 MCG INHALER","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"78206013601","LABEL_NAME":"FOSAMAX PLUS D 70 MG-5600 UNIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"78206013701","LABEL_NAME":"FOSAMAX PLUS D 70 MG-2800 UNIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"78206015001","LABEL_NAME":"PREGNYL 10,000 UNIT VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"78206018901","LABEL_NAME":"XACIATO 2% VAGINAL GEL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"78613020130","LABEL_NAME":"SYNDROS 5 MG/ML SOLUTION","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"78670014002","LABEL_NAME":"ZIMHI 5 MG/0.5 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"78670015001","LABEL_NAME":"IWILFIN 192 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"78742002644","LABEL_NAME":"RELION ULTRA THIN 30G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"78742002648","LABEL_NAME":"RELION MICRO THIN 33G LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"78742025769","LABEL_NAME":"TWIST LANCETS 30G","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"78742025770","LABEL_NAME":"TWIST LANCETS 32G","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"78742043574","LABEL_NAME":"SV VITAMIN B-6 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"79378000102","LABEL_NAME":"CHOLBAM 50 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"79378000202","LABEL_NAME":"CHOLBAM 250 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"79378011001","LABEL_NAME":"LIVMARLI 9.5 MG/ML ORAL SOLN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"79378011101","LABEL_NAME":"LIVMARLI 19 MG/ML ORAL SOLN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"79378021030","LABEL_NAME":"LIVMARLI 10 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"79378021530","LABEL_NAME":"LIVMARLI 15 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"79378022030","LABEL_NAME":"LIVMARLI 20 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"79378023030","LABEL_NAME":"LIVMARLI 30 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"79378031090","LABEL_NAME":"CTEXLI 250 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"79802020030","LABEL_NAME":"REZUROCK 200 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"79903012808","LABEL_NAME":"EQ NICOTINE 4 MG MINI LOZENGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"79903017204","LABEL_NAME":"EQ CHLD ACETAMINOPHEN 160 MG/5","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"80005011402","LABEL_NAME":"LOMUSTINE 10 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"80005011502","LABEL_NAME":"LOMUSTINE 40 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"80005011602","LABEL_NAME":"LOMUSTINE 100 MG CAPSULE","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"80196029272","LABEL_NAME":"PUSH BUTTON SAFETY 28G LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"80491801203","LABEL_NAME":"TRYVIO 12.5 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"80610010560","LABEL_NAME":"ZORYVE 0.05% CREAM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"80610011560","LABEL_NAME":"ZORYVE 0.15% CREAM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"80610013060","LABEL_NAME":"ZORYVE 0.3% CREAM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"80610043060","LABEL_NAME":"ZORYVE 0.3% FOAM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"80631020701","LABEL_NAME":"NUVAXOVID 2025-26 SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"80681015700","LABEL_NAME":"VITAMIN B COMPLEX-VITAMIN C TB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"80725014318","LABEL_NAME":"EULEXIN 125 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"80725061025","LABEL_NAME":"LEUKERAN 2 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"80725062025","LABEL_NAME":"MYLERAN 2 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"80725063025","LABEL_NAME":"TABLOID 40 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"80725082060","LABEL_NAME":"DROXIA 200 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"80725083060","LABEL_NAME":"DROXIA 300 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"80725084060","LABEL_NAME":"DROXIA 400 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"80739081218","LABEL_NAME":"KRAZATI 200 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"80777011201","LABEL_NAME":"SPIKEVAX 2025-26 (12Y UP) SYRG","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"80777011309","LABEL_NAME":"SPIKEVAX 2025-26 (6M-11Y) SYR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"80777034561","LABEL_NAME":"MRESVIA 50 MCG/0.5 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"80777040060","LABEL_NAME":"MNEXSPIKE 2025-26 (12Y UP) SYR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"80789000315","LABEL_NAME":"VIGAFYDE 100 MG/ML ORAL SOLN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"81131006041","LABEL_NAME":"RELION THIN 26G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"81131007164","LABEL_NAME":"SV FOLIC ACID 800 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"81131013347","LABEL_NAME":"RELION 2-IN-1 LANCET DEVICE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"81131013834","LABEL_NAME":"RELION INS SYR 1 ML 31GX15/64\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"81131013836","LABEL_NAME":"RELION INS SYR 0.5 ML 31GX6MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"81131013838","LABEL_NAME":"RELION INS SYR 0.3 ML 31GX6MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"81131018748","LABEL_NAME":"EQ IBUPROFEN 200 MG SOFTGEL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"81131024068","LABEL_NAME":"EQ SPACE CHAMBER-SMALL MASK","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"81131024069","LABEL_NAME":"EQ SPACE CHAMBER-MEDIUM MASK","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"81131024070","LABEL_NAME":"EQ SPACE CHAMBER-LARGE MASK","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"81131024071","LABEL_NAME":"EQ SPACE CHAMBER","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"81131031164","LABEL_NAME":"RELION INS SYR 0.5 ML 29GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"81131067887","LABEL_NAME":"SV PRENATAL TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"81279010420","LABEL_NAME":"ERGOMAR 2 MG TABLET SUBLINGUAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"81421002910","LABEL_NAME":"DULCOLAX 1,200 MG/15 ML LIQUID","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"81583010001","LABEL_NAME":"ZTALMY 50 MG/ML SUSPENSION","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"81603094205","LABEL_NAME":"DROPSAFE SICURA NDL 25G 25MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"81603966920","LABEL_NAME":"DROPSAFE MEDLANCE 30G LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"81665010210","LABEL_NAME":"ISOSORBIDE MONONIT 10 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"81665010310","LABEL_NAME":"ISOSORBIDE MONONIT 20 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"81749000401","LABEL_NAME":"TARPEYO DR 4 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"81802000172","LABEL_NAME":"CUVRIOR 300 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"81864010130","LABEL_NAME":"OJJAARA 200 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"81864010230","LABEL_NAME":"OJJAARA 150 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"81864010330","LABEL_NAME":"OJJAARA 100 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"81927020101","LABEL_NAME":"IMKELDI 80 MG/ML SOLUTION","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"81942012501","LABEL_NAME":"XDEMVY 0.25% DROP","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"81948625001","LABEL_NAME":"CEFACLOR 250 MG/5 ML SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"82154044901","LABEL_NAME":"PEGASYS 180 MCG/ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"82154045101","LABEL_NAME":"PEGASYS 180 MCG/0.5 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"82154078301","LABEL_NAME":"RUBRACA 200 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"82154078401","LABEL_NAME":"RUBRACA 250 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"82154078501","LABEL_NAME":"RUBRACA 300 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"82228071228","LABEL_NAME":"ATTRUBY 356 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"82249001112","LABEL_NAME":"ABIRTEGA 250 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"82448010014","LABEL_NAME":"OGSIVEO 100 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"82448013042","LABEL_NAME":"GOMEKLI 1 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"82448013442","LABEL_NAME":"GOMEKLI 1 MG TABLET FOR SUSP","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"82448015014","LABEL_NAME":"OGSIVEO 150 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"82448026042","LABEL_NAME":"GOMEKLI 2 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"82576006030","LABEL_NAME":"REZDIFFRA 60 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"82576008030","LABEL_NAME":"REZDIFFRA 80 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"82576010030","LABEL_NAME":"REZDIFFRA 100 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"82607054105","LABEL_NAME":"ON CALL 30G LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"82607054106","LABEL_NAME":"ON CALL LANCING DEVICE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"82625880101","LABEL_NAME":"MOVANTIK 12.5 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"82625880201","LABEL_NAME":"MOVANTIK 25 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"82667001205","LABEL_NAME":"NATACYN 5% EYE DROPS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"82867000101","LABEL_NAME":"LODOCO 0.5 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"82903005924","LABEL_NAME":"BD SAFETYGLIDE SYR 3 ML 25GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"82928030001","LABEL_NAME":"EKTERLY 300 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"82950000116","LABEL_NAME":"OJEMDA 100 MG TAB (400MG DOSE)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"82950000120","LABEL_NAME":"OJEMDA 100 MG TAB (500MG DOSE)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"82950000124","LABEL_NAME":"OJEMDA 100 MG TAB (600MG DOSE)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"82950001201","LABEL_NAME":"OJEMDA 25 MG/ML ORAL SUSP","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"83017010903","LABEL_NAME":"ULTRA-FINE PEN NEEDLE 31G 8MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"83017011903","LABEL_NAME":"ULTRA-FINE PEN NEEDLE 31G 5MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"83017012203","LABEL_NAME":"NANO PEN NEEDLE 32G 4MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"83017055003","LABEL_NAME":"NANO 2 GEN PEN NEEDLE 32G 4MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"83017074903","LABEL_NAME":"ULTRA-FINE PEN NEEDLE 32G 6MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"83017088003","LABEL_NAME":"ULTRA-FINE PEN NDL 29G 12.7MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"83017490603","LABEL_NAME":"ULTRA-FINE SYR 0.3 ML 31G 6MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"83017490703","LABEL_NAME":"ULTRA-FINE SYR 0.5 ML 31G 6MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"83017490803","LABEL_NAME":"ULTRA-FINE INS SYR 1ML 31G 6MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"83017491001","LABEL_NAME":"ULTRA-FINE 0.3ML 31G 6MM (1/2)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"83017673003","LABEL_NAME":"INS SYR U-500 0.5 ML 31G 6MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"83017827803","LABEL_NAME":"ULTRA-FINE SYR 1 ML 30G 12.7MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"83017827903","LABEL_NAME":"ULTRA-FINE 0.5 ML 30G 12.7MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"83017828003","LABEL_NAME":"ULTRA-FINE 0.3 ML 30G 12.7MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"83017828903","LABEL_NAME":"ULTRA-FINE INS SYR 1ML 31G 8MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"83017829003","LABEL_NAME":"ULTRA-FINE SYR 0.5 ML 31G 8MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"83017829103","LABEL_NAME":"ULTRA-FINE SYR 0.3 ML 31G 8MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"83017844001","LABEL_NAME":"ULTRA-FINE 0.3ML 31G 8MM (1/2)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"83017941003","LABEL_NAME":"INSULIN SYRINGE 1ML 28G 12.7MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"83017941203","LABEL_NAME":"INSULIN SYRINGE 1 ML 27G 16MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"83017946103","LABEL_NAME":"INSULIN SYR 0.5 ML 28G 12.7MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"83017951503","LABEL_NAME":"AUTOSHIELD DUO PEN NDL 30G 5MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"83034000301","LABEL_NAME":"OHTUVAYRE 3 MG/2.5ML INHAL SUS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"83035106203","LABEL_NAME":"TM-CLOTRIMAZOLE 1% TOP CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"83035182401","LABEL_NAME":"TRUE FOLIC ACID 667 MCG DFE TB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"83035182901","LABEL_NAME":"TRUE VITAMIN B-6 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"83035911201","LABEL_NAME":"TRUE COVER CONDOM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"83076102503","LABEL_NAME":"ENSACOVE 25 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"83076110006","LABEL_NAME":"ENSACOVE 100 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"83257002341","LABEL_NAME":"YESINTEK 45 MG/0.5 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"83257002411","LABEL_NAME":"YESINTEK 45 MG/0.5 ML VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"83257002541","LABEL_NAME":"YESINTEK 90 MG/ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"83296010012","LABEL_NAME":"XOLREMDI 100 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"83324000530","LABEL_NAME":"QC INF IBUPROFEN 50 MG/1.25 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"83324003330","LABEL_NAME":"QC GENTLE LAXATIVE EC 5 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"83324004101","LABEL_NAME":"QC CLOTRIMAZOLE 1% TOP CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"83324004701","LABEL_NAME":"QC HYDROCORTISONE 1% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"83324006130","LABEL_NAME":"QC LAXATIVE EC 5 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"83324007536","LABEL_NAME":"QC ASPIRIN 81 MG CHEWABLE TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"83324007601","LABEL_NAME":"QC PAIN RELIEF 325 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"83324008001","LABEL_NAME":"QC PAIN RELIEF 500 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"83324008350","LABEL_NAME":"QC 8HR ARTHRIT PAIN ER 650 MG","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"83324008701","LABEL_NAME":"QC ALLERGY (DIPHEN) 25 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"83324009114","LABEL_NAME":"QC ALLERGY (CETRZN) 10 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"83324013850","LABEL_NAME":"QC PAIN RELIEF 500 MG GELCAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"83324016015","LABEL_NAME":"QC MICONAZOLE 7 CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"83324020648","LABEL_NAME":"QC IBUPROFEN 200 MG SOFTGEL","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"83490023560","LABEL_NAME":"HYPER-SAL 3.5% VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"83649055801","LABEL_NAME":"VECAMYL 2.5 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"83787010331","LABEL_NAME":"ZELSUVMI 10.3% GEL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"83831013401","LABEL_NAME":"LUTRATE DEPOT 22.5 MG VIAL","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"83853010101","LABEL_NAME":"AQNEURSA 1 GRAM GRANULE PACKET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"83860002501","LABEL_NAME":"VYKAT XR 25 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"83860007501","LABEL_NAME":"VYKAT XR 75 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"83860015001","LABEL_NAME":"VYKAT XR 150 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"84015092060","LABEL_NAME":"PALSONIFY 20 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"84015093060","LABEL_NAME":"PALSONIFY 30 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"84141002501","LABEL_NAME":"REDEMPLO 25 MG/0.5 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"84415004102","LABEL_NAME":"GLYCERIN 2 GM ADULT SUPPOS","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"84521000588","LABEL_NAME":"MAGELLAN SAFETY 1 ML 23GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"84639021204","LABEL_NAME":"BRONCHITOL 40 MG INHALE CAP","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"84639021256","LABEL_NAME":"BRONCHITOL 40 MG INHALE CAP","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"84651020030","LABEL_NAME":"IBTROZI 200 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"84696020090","LABEL_NAME":"KOMZIFTI 200 MG CAPSULE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"84781087201","LABEL_NAME":"PUREVITA FOLIC ACID 400 MCG TB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"85320055107","LABEL_NAME":"MULPLETA 3 MG TABLET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":true,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"85325000054","LABEL_NAME":"CARESENS 30G LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"86227001810","LABEL_NAME":"SURE COMFORT 18G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"86227002110","LABEL_NAME":"SURE COMFORT 21G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"86227002310","LABEL_NAME":"SURE COMFORT 23G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"86227003011","LABEL_NAME":"SURE COMFORT 30G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"86227004035","LABEL_NAME":"CAREPOINT PRECISION LUER 3 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"86227005355","LABEL_NAME":"CAREPOINT LL SYR 3 ML 22G 1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"86227005365","LABEL_NAME":"CAREPOINT LL SYR 3 ML 22G 38MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"86227005375","LABEL_NAME":"CAREPOINT LL SYR 3 ML 23G 1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"86227018015","LABEL_NAME":"POLY HUB NEEDLE 18GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"86227018155","LABEL_NAME":"POLY HUB NEEDLE 18GX1-1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"86227018635","LABEL_NAME":"PUB INSUL SYR 0.3 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"86227018745","LABEL_NAME":"PUB INSUL SYR 0.5 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"86227019015","LABEL_NAME":"CAREPOINT LUER SLIP 1 ML SYRNG","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"86227021015","LABEL_NAME":"POLY HUB NEEDLE 21GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"86227021155","LABEL_NAME":"POLY HUB NEEDLE 21GX1-1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"86227022005","LABEL_NAME":"CAREPOINT PRECISION NDL 20G 1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"86227022015","LABEL_NAME":"POLY HUB NEEDLE 22GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"86227022105","LABEL_NAME":"CAREPOINT PRECISION NDL 21G 1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"86227022155","LABEL_NAME":"POLY HUB NEEDLE 22GX1-1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"86227023015","LABEL_NAME":"POLY HUB NEEDLE 23GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"86227023155","LABEL_NAME":"POLY HUB NEEDLE 23GX1-1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"86227025015","LABEL_NAME":"POLY HUB NEEDLE 25GX1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"86227025155","LABEL_NAME":"POLY HUB NEEDLE 25GX1-1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"86227025585","LABEL_NAME":"POLY HUB NEEDLE 25GX5/8\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"86227027055","LABEL_NAME":"POLY HUB NEEDLE 27GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"86227027125","LABEL_NAME":"POLY HUB NEEDLE 27GX1-1/4\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"86227028105","LABEL_NAME":"SURE COMFORT 28G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"86227030035","LABEL_NAME":"CAREPOINT LUER LOCK SYR 3 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"86227030055","LABEL_NAME":"POLY HUB NEEDLE 30GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"86227031055","LABEL_NAME":"CAREPOINT LL SYR 3 ML 20G 1.5\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"86227031115","LABEL_NAME":"CAREPOINT LL SYR 3 ML 21G 1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"86227031155","LABEL_NAME":"CAREPOINT LL SYR 3 ML 21G 1.5\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"86227031355","LABEL_NAME":"CAREPOINT LL SYR 3 ML 23G 1.5\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"86227031515","LABEL_NAME":"CAREPOINT LL SYR 3 ML 25G 1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"86227031585","LABEL_NAME":"CAREPOINT LL SYR 3 ML 25G 5/8\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"86227052205","LABEL_NAME":"SURE COMFORT LANCING PEN","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"86227062035","LABEL_NAME":"SURE COMFORT 3/10 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"86227062055","LABEL_NAME":"SURE COMFORT 0.5 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"86227062105","LABEL_NAME":"SURE COMFORT 1 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"86227064035","LABEL_NAME":"SURE COMFORT INS 0.3ML 31GX1/4","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"86227064055","LABEL_NAME":"SURE COMFORT INS 0.5ML 31GX1/4","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"86227064105","LABEL_NAME":"SURE COMFORT INS 1 ML 31GX1/4\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"86227065045","LABEL_NAME":"SURE COMFORT 0.3 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"86227071585","LABEL_NAME":"CAREPOINT LS SYR 1 ML 25G 5/8\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"86227082035","LABEL_NAME":"CAREPOINT SAFETY LL 1ML 25G 1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"86227082045","LABEL_NAME":"CAREPOINT SAFTY 1ML 23G 25.4MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"86227099005","LABEL_NAME":"HEALTHWISE INS 0.3ML 30GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"86227099015","LABEL_NAME":"HEALTHWISE INS 0.5ML 30GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"86227099025","LABEL_NAME":"HEALTHWISE INS 1 ML 30GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"86227099035","LABEL_NAME":"HEALTHWISE INS 0.3ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"86227099045","LABEL_NAME":"HEALTHWISE INS 0.5ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"86227099055","LABEL_NAME":"HEALTHWISE INS 1 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"87701030771","LABEL_NAME":"GNP CHLD IBUPROFEN 100 MG/5 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"87701040217","LABEL_NAME":"GNP COLD-COUGH ELIXIR","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"87701040346","LABEL_NAME":"GNP MICONAZOLE 2% SPRAY POWDER","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"87701040389","LABEL_NAME":"GNP LORATADINE 5 MG/5 ML SYRUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"87701040399","LABEL_NAME":"GNP ALL DAY ALLERGY 10 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"87701040471","LABEL_NAME":"GNP TERBINAFINE 1% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"87701040587","LABEL_NAME":"GNP CLEARLAX POWDER","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"87701040730","LABEL_NAME":"GNP VITAMIN B-6 100 MG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"87701040733","LABEL_NAME":"GNP FOLIC ACID 400 MCG TABLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"87701042606","LABEL_NAME":"GNP STERILE 33G LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"87701042608","LABEL_NAME":"GNP INS SYRINGE 1 ML 28G 1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"87701042814","LABEL_NAME":"GNP CLEARLAX POWDER PACKET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"87701042901","LABEL_NAME":"GNP BUDESONIDE 32 MCG SPRAY","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"87701042959","LABEL_NAME":"GNP CHLD LORATADINE 5 MG/5 ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"87701043136","LABEL_NAME":"GNP ALLERGY RELIEF 25 MG CAP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"87701052620","LABEL_NAME":"GNP LANCING SYSTEM DEVICE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"87701054973","LABEL_NAME":"GNP HYDROCORTISONE 1% OINTMENT","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"87701055205","LABEL_NAME":"GNP SALINE 0.65% NOSE SPRAY","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"87701060152","LABEL_NAME":"GNP MILK OF MAGNESIA SUSP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"87701064954","LABEL_NAME":"GNP DIPHEDRYL 12.5 MG/5 ML ELX","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"87701074702","LABEL_NAME":"GNP ULTR CMFRT 0.5 ML 28GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"87701074725","LABEL_NAME":"GNP ULT C 0.3ML 29GX1/2\" (1/2)","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"87701074728","LABEL_NAME":"GNP ULT CMFRT 0.5 ML 29GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"87701075605","LABEL_NAME":"GNP IBUPROFEN 200 MG CAPLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"87701079215","LABEL_NAME":"GNP ASPIRIN 81 MG CHEWABLE TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"87701079251","LABEL_NAME":"GNP MICONAZOLE 7 CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"87701082463","LABEL_NAME":"GNP CHILD PAIN-FEVER 160 MG/5","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"87701090058","LABEL_NAME":"GNP PAIN RELIEVER 325 MG TAB","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"87701092131","LABEL_NAME":"GNP MICONAZOLE 3 COMBO PACK","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"87701093206","LABEL_NAME":"GNP ALLERGY RELF 5 MG/5 ML SLN","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"87701095927","LABEL_NAME":"GNP INF IBUPROFEN 50 MG/1.25ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"87701096346","LABEL_NAME":"GNP TUSSIN DM SYRUP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"87701098111","LABEL_NAME":"GNP HYDROCORTISONE 1% CREAM","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"89134050202","LABEL_NAME":"MAXI-COMFORT INS 0.5 ML 28G","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"89134050302","LABEL_NAME":"MAXI-COMFORT INS 1 ML 28GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"89134052602","LABEL_NAME":"MAXICOMFORT INS 0.5ML 27GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"89134052702","LABEL_NAME":"MAXICOMFORT INS 1 ML 27GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"89134052802","LABEL_NAME":"ULTRA-THIN II INS 0.5 ML 29G","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"89134052902","LABEL_NAME":"ULTRA-THIN II INS SYR 1 ML 29G","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"89134061802","LABEL_NAME":"ULTRA-THIN II INS 0.5 ML 30G","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"89134062002","LABEL_NAME":"ULTRA-THIN II INS SYR 1 ML 30G","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"89134072202","LABEL_NAME":"ULTRA-THIN II INS 0.3 ML 30G","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"89134072602","LABEL_NAME":"ULTRA-THIN II 28G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"89134072802","LABEL_NAME":"ULTRA-THIN II 30G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"89134074002","LABEL_NAME":"ULTRA-THIN II INS 0.3 ML 31G","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"89134074202","LABEL_NAME":"ULTRA-THIN II INS 0.5 ML 31G","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"89134074402","LABEL_NAME":"ULTRA-THIN II 1 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"89134075802","LABEL_NAME":"MINI LANCING DEVICE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"90166001334","LABEL_NAME":"LANCETS 33G","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"90166010205","LABEL_NAME":"EASY GLIDE LUER LOCK 10 ML SYR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"90166012102","LABEL_NAME":"E-Z PULL & CLICK LANCING DEV","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"90166012505","LABEL_NAME":"EASY GLIDE LUER SLIP TB 1 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"90166012804","LABEL_NAME":"INJECT EASE 28G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"90166013004","LABEL_NAME":"INJECT EASE 30G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"90166013505","LABEL_NAME":"EASY GLIDE LUER LOCK 1 ML SYR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"90166013645","LABEL_NAME":"EASY GLIDE INS 1 ML 31GX6MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"90166022805","LABEL_NAME":"PERFECT POINT 28G SAFETY LANCT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"90166023005","LABEL_NAME":"PERFECT POINT 30G SAFETY LANCT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"90166023645","LABEL_NAME":"EASY GLIDE INS 0.5 ML 31GX6MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"90166025105","LABEL_NAME":"PERFECT POINT NEEDLE 25G 1\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"90166030305","LABEL_NAME":"EASY GLIDE LUER LOCK 3 ML SYR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"90166031645","LABEL_NAME":"EASY GLIDE INS 0.3 ML 31GX6MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"91237000108","LABEL_NAME":"EASY COMFORT INSULIN 1 ML SYR","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"91237000109","LABEL_NAME":"EASY COMFORT 0.5 ML SYRINGE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"91237000115","LABEL_NAME":"EASY COMFORT 30G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"91237000117","LABEL_NAME":"EASY MINI EJECT LANCING DEVICE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"91237000171","LABEL_NAME":"EASY COMFORT 0.5 ML 30GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"91237000172","LABEL_NAME":"EASY COMFORT SYR 1 ML 30GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"91237000188","LABEL_NAME":"EASY COMFORT 0.5 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"91237000189","LABEL_NAME":"EASY COMFORT 1 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"93815097137","LABEL_NAME":"ULTRATLC LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"94030000204","LABEL_NAME":"EMBRACE 30G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"94030000251","LABEL_NAME":"EMBRACE 21G SAFETY LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"94030000266","LABEL_NAME":"EMBRACE 28G SAFETY LANCET","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"94030000268","LABEL_NAME":"EMBRACE LANCING DEVICE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"94046000106","LABEL_NAME":"ADVOCATE 30G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"94046000162","LABEL_NAME":"ADVOCATE INS SYR 1 ML 30GX5/16","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"94046000164","LABEL_NAME":"ADVOCATE INS 0.5 ML 30GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"94046000166","LABEL_NAME":"ADVOCATE INS 0.3 ML 30GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"94046000168","LABEL_NAME":"ADVOCATE INS 1 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"94046000170","LABEL_NAME":"ADVOCATE INS 0.5 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"94046000172","LABEL_NAME":"ADVOCATE INS 0.3 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"94046000192","LABEL_NAME":"ADVOCATE 26G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"96295012826","LABEL_NAME":"CHILD MULTIVITAMIN PLUS IRON","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"96295012831","LABEL_NAME":"PRENATAL CAPLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"96295013884","LABEL_NAME":"SUPER B COMPLEX-VIT C CAPLET","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"96295014064","LABEL_NAME":"INFANT VITAMIN D 10 MCG/ML DRP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"98302000100","LABEL_NAME":"SIMPLE DIAGNSTIC LANCET DEVICE","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"98302000104","LABEL_NAME":"PHARMACIST CHOICE 30G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"98302000106","LABEL_NAME":"ULTRA THIN 28G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"98302000115","LABEL_NAME":"CLEVER CHEK ULTRA THIN 30G","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"98302000125","LABEL_NAME":"PHARMACIST CHOICE 30G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"98302000126","LABEL_NAME":"PHARMACIST CHOICE 28G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"98302000160","LABEL_NAME":"ULTRA THIN 31G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"98302001407","LABEL_NAME":"PHARMACIST CHOICE 33G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"98302013920","LABEL_NAME":"COMFORT EZ INSULIN SYR 0.3 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"98302013930","LABEL_NAME":"COMFORT EZ INSULIN SYR 0.5 ML","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"98302013931","LABEL_NAME":"COMFORT EZ INS 0.3ML 30GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"98302013933","LABEL_NAME":"COMFORT EZ SYR 1 ML 30GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"98302013934","LABEL_NAME":"COMFORT EZ INS 0.3ML 30GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"98302013935","LABEL_NAME":"COMFORT EZ SYR 0.5 ML 30GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"98302013936","LABEL_NAME":"COMFORT EZ SYR 1 ML 30GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"98302013937","LABEL_NAME":"COMFORT EZ SYR 0.5 ML 29GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"98302013938","LABEL_NAME":"COMFORT EZ SYR 1 ML 29GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"98302013939","LABEL_NAME":"COMFORT EZ SYR 0.5 ML 28GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"98302013940","LABEL_NAME":"COMFORT EZ SYR 1 ML 28GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"98302013941","LABEL_NAME":"COMFORT EZ SYR 0.3 ML 29GX1/2\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"98302014002","LABEL_NAME":"PHARM CHOICE D3 400 UNIT/ML","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"98302014006","LABEL_NAME":"PHARM CHC PED IRON 15MG/ML DRP","plans":[{"tier_level":"1","plan_id":"VA","drug_tier":"Generics","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"98302014020","LABEL_NAME":"COMFORT EZ PRESSURE ACTIVT 28G","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"98302014023","LABEL_NAME":"COMFORT EZ SAFETY 23G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"98302014043","LABEL_NAME":"COMFORT EZ SYR 1 ML 27G 12.7MM","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"98302014044","LABEL_NAME":"COMFORT EZ 0.3 ML 31G 15/64\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"98302014045","LABEL_NAME":"COMFORT EZ 0.5 ML 31G 15/64\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"98302014046","LABEL_NAME":"COMFORT EZ INS 1 ML 31G 15/64\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"98302014200","LABEL_NAME":"COMFORT EZ SAFETY 28G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"98939000261","LABEL_NAME":"FORACARE 30G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"99073011001","LABEL_NAME":"FREESTYLE SYSTEM KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"99073012050","LABEL_NAME":"FREESTYLE TEST STRIPS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"99073013001","LABEL_NAME":"FREESTYLE 28G LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"99073014002","LABEL_NAME":"FREESTYLE CONTROL SOLUTION","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"99073014003","LABEL_NAME":"FREESTYLE CONTROL SOLUTION","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"99073070428","LABEL_NAME":"FREESTYLE UNISTIK 2 LANCETS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"99073070805","LABEL_NAME":"FREESTYLE LITE METER","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"99073070822","LABEL_NAME":"FREESTYLE LITE TEST STRIP","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"99073070847","LABEL_NAME":"FREESTYLE FREEDOM KIT","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"99073070914","LABEL_NAME":"FREESTYLE FREEDOM LITE METER","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"99073071097","LABEL_NAME":"FREESTYLE PREC 1 ML 30GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"99073071098","LABEL_NAME":"FREESTYLE PREC 0.5 ML 30GX5/16","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"99073071099","LABEL_NAME":"FREESTYLE PREC 0.5 ML 31GX5/16","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"99073071100","LABEL_NAME":"FREESTYLE PREC 1 ML 31GX5/16\"","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":false}]},{"NDC_FORMAT_CODE":"99073071143","LABEL_NAME":"FREESTYLE INSULINX GLUCOSE SYS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":true,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"99073071227","LABEL_NAME":"FREESTYLE INSULINX TEST STRIPS","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]},{"NDC_FORMAT_CODE":"99073071231","LABEL_NAME":"FREESTYLE INSULINX TEST STRIP","plans":[{"tier_level":"2","plan_id":"VA","drug_tier":"Brand","prior_authorization":false,"step_therapy":false,"quantity_limit":false,"year":[2026],"state":"VA","otc":true}]}]