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			{
				"drug_tier": "GENERIC",
				"mail_order": true,
				"cost_sharing": [
					{
						"pharmacy_type": "30 Day Supply at Retail",
						"copay_amount": 5.0,
						"copay_opt": "BEFORE-DEDUCTIBLE",
						"coinsurance_rate": 0.0,
						"coinsurance_opt": null
					},
					{
						"pharmacy_type": "90 Day Supply at Retail or Mail",
						"copay_amount": 12.5,
						"copay_opt": "BEFORE-DEDUCTIBLE",
						"coinsurance_rate": 0.0,
						"coinsurance_opt": null
					}
				]
			},
			{
				"drug_tier": "PREFERRED-BRAND",
				"mail_order": true,
				"cost_sharing": [
					{
						"pharmacy_type": "30 Day Supply at Retail",
						"copay_amount": 20.0,
						"copay_opt": "BEFORE-DEDUCTIBLE",
						"coinsurance_rate": 0.0,
						"coinsurance_opt": null
					},
					{
						"pharmacy_type": "90 Day Supply at Retail or Mail",
						"copay_amount": 50.0,
						"copay_opt": "BEFORE-DEDUCTIBLE",
						"coinsurance_rate": 0.0,
						"coinsurance_opt": null
					}
				]
			},
			{
				"drug_tier": "NON-PREFERRED-BRAND",
				"mail_order": true,
				"cost_sharing": [
					{
						"pharmacy_type": "30 Day Supply at Retail",
						"copay_amount": 60.0,
						"copay_opt": "BEFORE-DEDUCTIBLE",
						"coinsurance_rate": 0.0,
						"coinsurance_opt": null
					},
					{
						"pharmacy_type": "90 Day Supply at Retail or Mail",
						"copay_amount": 150.0,
						"copay_opt": "BEFORE-DEDUCTIBLE",
						"coinsurance_rate": 0.0,
						"coinsurance_opt": null
					}
				]
			},
			{
				"drug_tier": "SPECIALTY-DRUGS",
				"mail_order": false,
				"cost_sharing": [
					{
						"pharmacy_type": "30 Day Supply at Retail",
						"copay_amount": 0.0,
						"copay_opt": null,
						"coinsurance_rate": 0.5,
						"coinsurance_opt": "BEFORE-DEDUCTIBLE"
					}
				]
			}
		],
		"benefits": [
			{
				"telemedicine": true
			}
		],
		"last_updated_on": "2026-09-09",
		"years": [
			2027
		]
	}
]