{"text_format":"2","workbook":"xls","n_sheets":4,"sheets":["EnableMacros","Formulary Tiers","Drug Lists","Names"],"not_rendered":{"charts":0,"images":0,"macros":1,"external_links":1,"defined_names":11,"comments":0,"pivot_tables":0},"unopened":[],"bounds":{"document_bytes":16777216,"sheet_cells":100000,"run_cost":"one","rows_first":2000,"rows_last":500,"rows_between":2000,"halvings":0,"cell_chars":16384,"cell_head_chars":4096},"cells_cut":0,"cells_raw":0,"read":"whole","date_system":"1900","formulas":"cached_only"}

{"sheet":"EnableMacros","index":0,"n_rows":17,"n_cols":2,"rows_kept":17,"cut":false,"hidden":true,"merged":[[0,0,0,15],[1,0,1,15],[2,0,2,15]],"flags":["formulas_cached_only"]}
["Prescription Drug Template"]
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[null,"If you are seeing this sheet, macros are not enabled, please follow the following steps: "]
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[null,"If using Excel 2007 and 2010:"]
[null,"1. Set the macro security setting to Disable macros with notifications (Recommended) or Enable all macros. To change"]
[null,"    the macro security setting, click the Office Button and select Excel Option -> Trust Center -> Trust Center Settings -> "]
[null,"    Macro Settings."]
[null,"2. If the macro security setting is set to Disable macros with notifications, click the Option button and select Enable this "]
[null,"    content."]
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[]
[null,"Note: This screen will flash momentarily when you save or finalize this workbook."]

{"sheet":"Formulary Tiers","index":1,"n_rows":12,"n_cols":17,"rows_kept":12,"cut":false,"hidden":false,"merged":[],"flags":["formulas_cached_only"]}
[null,null,null,"All fields with an asterisk (*) are required. To validate the template, press the Validate button or Ctrl + Shift + I. To finalize, press Finalize button or Ctrl + Shift + F."]
["If macros are disabled, press and hold the ALT key and press the F, then I, and then N key. After that, select the Enable All Content option by pressing enter. (note that you can also press the C key to select \"Enable All Content\").  Instructions can be found in cells D1 through D5.",null,null,"Click the Create Formulary IDs button (or Ctrl + Shift + C) to create Formulary IDs."]
[null,null,null,"After creating Formulary IDs, select the ID from the drop down in Column A and 7 tiers will automatically be populated."]
[null,null,null,"Select how many tiers a formulary uses from Number of Tiers and unused rows (tiers) will be greyed out."]
[null,null,null,"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* "]
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["Formulary ID*","Formulary URL*","Drug List ID*","Number of Tiers*","Drug Tier ID*","Drug Tier Type*","1 Month In Network Retail Pharmacy Copayment*","1 Month In Network Retail Pharmacy Coinsurance*","1 Month Out of Network Retail Pharmacy Benefit Offered?*","1 Month Out of Network Retail Pharmacy Copayment*","1 Month Out of Network Retail Pharmacy Coinsurance*","3 Month In Network Mail Order Pharmacy Benefit Offered?*","3 Month In Network Mail Order Pharmacy Copayment*","3 Month In Network Mail Order Pharmacy Coinsurance*","3 Month Out of Network Mail Order Pharmacy Benefit Offered?*","3 Month Out of Network Mail Order Pharmacy Copayment*","3 Month Out of Network Mail Order Pharmacy 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 1-7","Required:\nSelect all the Drug Tier Types included in this tier","Required: Enter a copayment amount","Required: Enter a coinsurance amount","Required:\nDoes this tier offer 1 Month Out of Network Retail Pharmacy Benefits?","Required if Offered: Enter a copayment amount","Required if Offered: Enter a coinsurance amount","Required:\nDoes this tier offer 3 Month In Network Mail Order Pharmacy Benefits?","Required if Offered: Enter a copayment amount","Required if Offered: Enter a coinsurance amount","Required:\nDoes this tier offer 3 Month Out of Network Mail Order Benefits?","Required if Offered: Enter a copayment amount","Required if Offered: Enter a coinsurance amount"]

{"sheet":"Drug Lists","index":2,"n_rows":8,"n_cols":4,"rows_kept":8,"cut":false,"hidden":false,"merged":[[5,1,5,3]],"flags":["formulas_cached_only"]}
["Drug Lists","All fields with an asterisk (*) are required. To validate the template, press the Validate button or Ctrl + Shift + I. To finalize, press Finalize button or Ctrl + Shift + F."]
["Instruction can be found in cells B1 through B5","Click the Create Formulary IDs button (or Ctrl + Shift + C) to create Formulary IDs."]
[null,"After creating Formulary IDs, select the ID from the drop down in Column A and 7 tiers will automatically be populated."]
[null,"Select how many tiers a formulary uses from Number of Tiers and unused rows (tiers) will be greyed out."]
[null,"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)."]
[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"]

{"sheet":"Names","index":3,"n_rows":51,"n_cols":8,"rows_kept":51,"cut":false,"hidden":true,"merged":[],"flags":["formulas_cached_only"]}
["Generic",1,"Yes","NA",1,null,"AK","No Charge"]
["Preferred Generic",2,"No",1,null,null,"AL","No Charge after deductible"]
["Non-Preferred Generic",3,null,2,null,null,"AR","$X"]
["Brand",4,null,3,null,null,"AZ","$X Copay after deductible"]
["Preferred Brand",5,null,4,null,null,"CA","$X Copay with deductible"]
["Non-Preferred Brand",6,null,5,null,null,"CO","Not Applicable"]
["Specialty Drugs",7,null,6,null,null,"CT"]
["Zero Cost Share Preventive Drugs",null,null,7,null,null,"DC","No Charge"]
["Medical Service Drugs",{"$nulls":5},"DE","No Charge after deductible"]
[{"$nulls":6},"FL","X%"]
[{"$nulls":6},"GA","X% Coinsurance after deductible"]
[{"$nulls":6},"HI","Not Applicable"]
[{"$nulls":6},"IA"]
[{"$nulls":6},"ID"]
[{"$nulls":6},"IL"]
[{"$nulls":6},"IN"]
[{"$nulls":6},"KS"]
[{"$nulls":6},"KY"]
[{"$nulls":6},"LA"]
[{"$nulls":6},"MA"]
[{"$nulls":6},"MD"]
[{"$nulls":6},"ME"]
[{"$nulls":6},"MI"]
[{"$nulls":6},"MN"]
[{"$nulls":6},"MO"]
[{"$nulls":6},"MS"]
[{"$nulls":6},"MT"]
[{"$nulls":6},"NC"]
[{"$nulls":6},"ND"]
[{"$nulls":6},"NE"]
[{"$nulls":6},"NH"]
[{"$nulls":6},"NJ"]
[{"$nulls":6},"NM"]
[{"$nulls":6},"NV"]
[{"$nulls":6},"NY"]
[{"$nulls":6},"OH"]
[{"$nulls":6},"OK"]
[{"$nulls":6},"OR"]
[{"$nulls":6},"PA"]
[{"$nulls":6},"RI"]
[{"$nulls":6},"SC"]
[{"$nulls":6},"SD"]
[{"$nulls":6},"TN"]
[{"$nulls":6},"TX"]
[{"$nulls":6},"UT"]
[{"$nulls":6},"VA"]
[{"$nulls":6},"VT"]
[{"$nulls":6},"WA"]
[{"$nulls":6},"WI"]
[{"$nulls":6},"WV"]
[{"$nulls":6},"WY"]