{"text_format":"3","workbook":"xlsx","n_sheets":2,"sheets":["Formulary Tiers","Drug Lists"],"not_rendered":{"macros":1,"defined_names":17},"read":"row_number_cap","date_system":"1900"}

{"sheet":"Formulary Tiers","index":0,"n_rows":1048576,"n_cols":21,"rows_kept":1048576,"read":"row_number_cap"}
["Prescription Drug Formulary Template",null,null,"All fields with an asterisk (*) are required. To validate the template, press the Validate button or Ctrl + Shift + V. To finalize, press Finalize button or Ctrl + Shift + F."]
["Go to cell D1 for instructions",null,null,"Click the Create Formulary IDs button (or Ctrl + Shift + C) to create Formulary IDs."]
[{"$nulls":3},"After creating Formulary IDs, select the ID from the drop down in Column A and 7 tiers will automatically be popoulated."]
[{"$nulls":3},"Select how many tiers a formulary uses from Number of Tiers and unused rows (tiers) will be greyed out."]
[{"$nulls":3},"Enter all RXCUIs on the Drug Lists sheet. To add more drug lists, click Add Drug List (Ctrl + Shift + A) and to delete the last drug list added press Delete Drug Lists (or Ctrl + Shift + D)."]
["HIOS Issuer ID* "]
["Issuer State* "]
[]
[]
[]
["Formulary ID*","Formulary URL*","Drug List ID*","Number of Tiers*","Drug Tier ID*","Drug Tier Type*","1 Month In Network Retail Pharmacy Cost Sharing Type*"," Copayment*\n(Please enter a dollar amount)","Coinsurance*","1 Month Out of Network Retail Pharmacy Benefit Offered?*","1 Month Out of Network Retail Pharmacy Cost Sharing Type "," Copayment*\n(Please enter a dollar amount)","Coinsurance ","3 Month In Network Mail Order Pharmacy Benefit Offered?*","3 Month In Network Mail Order Pharmacy Cost Sharing Type"," Copayment \n(Please enter a dollar amount)","Coinsurance ","3 Month Out of Network Mail Order Pharmacy Benefit Offered?*","3 Month Out of Network Mail Order Pharmacy Cost Sharing Type "," Copayment (Please enter a dollar amount)","Coinsurance "]
["Required:\nSelect the Formulary ID","Required:\nEnter the Formulary URL","Required:\nSelect the Drug List ID \n(from Drug Lists sheet)","Required:\nSelect the number of Tiers","Required:\nThe template will populate a Drug Tier ID 1-10","Required:\nSelect all the Drug Types included in this tier","Required:\nSelect the Cost Sharing Type","Required:\nEnter the Copayment for 1 Month In Network Retail Pharmacy","Required:\nEnter the Coinsurance for 1 Month In Network Retail Pharmacy","Required:\nDoes this tier offer 1 Month Out of Network Retail Pharmacy benefits?","Required if Offered:\nSelect the Cost Sharing Type","Required if Offered:\nEnter the Copayment for 1 Month Out of Network Retail Pharmacy","Required if Offered:\nEnter the Coinsurance for 1 Month Out of Network Retail Pharmacy","Required:\nDoes this tier offer 3 Month In Network Mail Order Pharmacy benefits?","Required if Offered:\nSelect the Cost Sharing Type","Required if Offered:\nEnter the Copayment for 3 Month In Network Mail Order","Required if Offered:\nEnter the Coinsurance for 3 Month In Network Mail Order","Required:\nDoes this tier offer 3 Month Out of Network Mail Order benefits?","Required if Offered:\nSelect the Cost Sharing Type","Required if Offered:\nEnter the Copayment for 3 Month Out of Network Mail Order","Required if Offered:\nEnter the Coinsurance for 3 Month Out of Network Mail Order"]
[]
[]
[]
[]
[{"$nulls":5}," "]
{"$rows_empty":5023}
[{"$nulls":5},"All brands, All preferred brands, All non-preferred brands"]
{"$rows_empty":96280}
[{"$nulls":5},"All brands, All preferred brands, All non-preferred brands"]
{"$rows_empty":947021}
["AK",null,null,1,null,"All generics"]
["AL",null,null,2,null,"All preferred generics"]
["AR",null,null,3,null,"All non-preferred generics"]
["AS",null,null,4,null,"Only select generics"]
["AZ",null,null,5,null,"All brands"]
["CA",null,null,6,null,"All preferred brands"]
["CO",null,null,7,null,"All non-preferred brands"]
["CT",null,null,8,null,"Only select brands"]
["DC",null,null,9]
["DE",null,null,10]
["FL"]
["FM"]
["GA"]
["GU"]
["HI"]
["IA"]
["ID"]
["IL"]
["IN"]
["KS"]
["KY"]
["LA"]
["MA"]
["MD"]
["ME"]
["MH"]
["MI"]
["MN"]
["MO"]
["MP"]
["MS"]
["MT"]
["NC"]
["ND"]
["NE"]
["NH"]
["NJ"]
["NM"]
["NV"]
["NY"]
["OH"]
["OK"]
["OR"]
["PA"]
["PR"]
["PW"]
["RI"]
["SC"]
["SD"]
["TN"]
["TX"]
["UT"]
["VA"]
["VI"]
["VT"]
["WA"]
["WI"]
["WV"]
["WY"]
{"$rows_empty":170}
[{"$nulls":6},"Copayment","Yes"]
[{"$nulls":6},"Coinsurance","No"]
[{"$nulls":6},"Lesser of Copayment or Coinsurance"]
[{"$nulls":6},"Greater of Copayment or Coinsurance"]

{"sheet":"Drug Lists","index":1,"n_rows":1010,"n_cols":4,"rows_kept":1010,"merged":[[5,1,5,3]]}
["Drug Lists"]
[]
[]
[]
[]
[null,"Drug List ID 1"]
["RXCUI*","Tier Level*","Prior Authorization Required","Step Therapy Required"]
["Required:\nEnter the RXCUI","Required:\nSelect the Tier this drug is in, or select NA if this drug is not a part of this Drug List","Required if Tier Level is not NA:\nSelect \"Yes\" if Prior Authorization is Required","Required if Tier Level is not NA:\nSelect \"Yes\" if Step Therapy is Required"]
{"$rows_empty":991}
[null,"NA","Yes","Yes"]
[null,1,"No","No"]
[null,2]
[null,3]
[null,4]
[null,5]
[null,6]
[null,7]
[null,8]
[null,9]
[null,10]