CONTRACT_ID|PLAN_ID|SEGMENT_ID|TIER|DAYS_SUPPLY|copay_amt_pref_insln|copay_amt_nonpref_insln|copay_amt_mail_pref_insln|copay_amt_mail_nonpref_insln
H0028|007|000|.|1| |35.00| |35.00
H0028|007|000|.|2| |105.00| |105.00
H0028|014|000|1|1| |0.00|0.00|10.00
H0028|014|000|1|2| |0.00|0.00|30.00
H0028|014|000|2|1| |5.00|5.00|20.00
H0028|014|000|2|2| |15.00|0.00|60.00
H0028|014|000|3|1| |35.00|35.00|35.00
H0028|014|000|3|2| |105.00|95.00|105.00
H0028|014|000|4|1| |35.00|35.00|35.00
H0028|014|000|4|2| |105.00|105.00|105.00
H0028|014|000|5|1| |35.00|35.00|35.00
H0028|015|000|.|1| |35.00| |35.00
H0028|015|000|.|2| |105.00| |105.00
H0028|016|000|1|1| |6.00|6.00|10.00
H0028|016|000|1|2| |18.00|0.00|30.00
H0028|016|000|2|1| |11.00|11.00|20.00
H0028|016|000|2|2| |33.00|0.00|60.00
H0028|016|000|3|1| |35.00|35.00|35.00
H0028|016|000|3|2| |105.00|95.00|105.00
H0028|016|000|4|1| |35.00|35.00|35.00
H0028|016|000|4|2| |105.00|105.00|105.00
H0028|016|000|5|1| |35.00|35.00|35.00
H0028|017|000|1|1| |6.00|6.00|10.00
H0028|017|000|1|2| |18.00|0.00|30.00
H0028|017|000|2|1| |11.00|11.00|20.00
H0028|017|000|2|2| |33.00|0.00|60.00
H0028|017|000|3|1| |35.00|35.00|35.00
H0028|017|000|3|2| |105.00|95.00|105.00
H0028|017|000|4|1| |35.00|35.00|35.00
H0028|017|000|4|2| |105.00|105.00|105.00
H0028|017|000|5|1| |35.00|35.00|35.00
H0028|019|000|1|1| |0.00|0.00|10.00
H0028|019|000|1|2| |0.00|0.00|30.00
H0028|019|000|2|1| |8.00|8.00|20.00
H0028|019|000|2|2| |24.00|0.00|60.00
H0028|019|000|3|1| |35.00|35.00|35.00
H0028|019|000|3|2| |105.00|70.00|105.00
H0028|019|000|4|1| |35.00|35.00|35.00
H0028|019|000|4|2| |105.00|105.00|105.00
H0028|019|000|5|1| |35.00|35.00|35.00
H0028|021|000|1|1| |5.00|5.00|10.00
H0028|021|000|1|2| |15.00|0.00|30.00
H0028|021|000|2|1| |10.00|10.00|20.00
H0028|021|000|2|2| |30.00|0.00|60.00
H0028|021|000|3|1| |35.00|35.00|35.00
H0028|021|000|3|2| |105.00|70.00|105.00
H0028|021|000|4|1| |35.00|35.00|35.00
H0028|021|000|4|2| |105.00|105.00|105.00
H0028|021|000|5|1| |35.00|35.00|35.00
H0028|023|000|1|1| |3.00|3.00|10.00
